Skip Navigation LinksHome > March 2002 - Volume 96 - Issue 3 > A Qualitative and Quantitative Systematic Review of Preempti...
Anesthesiology:
Review Article

A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain Relief: The Role of Timing of Analgesia

Møiniche, Steen M.D.*; Kehlet, Henrik M.D., D.M.Sc.†; Dahl, Jørgen Berg M.D., D.M.Sc.‡

Free Access
Article Outline
Collapse Box

Author Information

THE concept of preemptive analgesia to reduce the magnitude and duration of postoperative pain was paved in 1983 by Woolf, 1 who showed evidence for a central component of postinjury pain hypersensitivity in experimental studies. Subsequently, an overwhelming amount of experimental data demonstrated that various antinociceptive techniques applied before injury were more effective in reducing the postinjury central sensitization phenomena as compared with administration after injury. 2 Finally, these promising experimental findings were taken into clinical testing of the hypothesis. Although early reviews of clinical findings were mostly negative, 3–5 there is still a widespread belief of the efficacy of preemptive analgesia among clinicians.
The definition of preemptive analgesia has varied, thereby causing confusion and misunderstanding of the concept. 6 Because the original observations in experimental studies suggested that timing of analgesic treatment was important to obtain efficient reduction of postinjury pain hypersensitivity phenomena, we performed an updated review of studies to compare the role of timing of analgesia i.e., preoperative versus intraoperative or postoperative initiation of analgesia. In this review we are not considering studies designed to compare preemptive analgesia versus no treatment. We have only included double-blind, randomized, controlled trials of identical or very similar analgesic regimens, where the only difference between study groups was timing of analgesia.
Back to Top | Article Outline

Methods

Literature Search
Reports of randomized controlled trials of preemptive analgesia for acute or chronic postoperative pain relief were systematically sought using the Cochrane Library 2000 § (www.cochrane.org) and the MEDLINE (www.ncbi.nlm.nih.gov/PubMed/; 1966–2000) databases without language restriction. We used different search strategies with free text combinations, including the following search terms: preemptive analgesia, preemptive analgesia, prophylactic pain treatment, preoperative treatment, postoperative pain, postoperative analgesia, chronic pain, and long-term pain. The last search was performed on December 30, 2000. Reference lists of retrieved reports and review articles were hand-searched for additional papers. No abstracts, correspondences, or unpublished observations were included. Authors were not contacted for original data.
Back to Top | Article Outline
Inclusion and Exclusion Criteria and Data Extraction
Reports that were included consisted of double-blind randomized comparisons of identical or nearly identical analgesic regimens initiated before versus after surgical incision for postoperative pain relief with or without the use of a double dummy.
Reports that were excluded included trials of comparisons of preoperative treatment with placebo or no treatment, and trials of comparisons of preoperative with preoperative plus postoperative treatment. Such studies provide no evidence for a preemptive effect, i.e., if timing of the initiation of the pain treatment is of importance. 5
We developed standard data collection sheets to record details of trial design, interventions, and outcome measures for every trial. Each report meeting the inclusion criteria was read independently by two of the authors and scored using a three-item, 1–5 quality scale. 7 Consensus was subsequently achieved. If the reports were described as randomized, one point was given, and an additional point was given if the method of randomization was described and adequate (computer-generated, table of random numbers, etc.), but one point was deducted if randomization was inappropriate (alternate randomization, randomization according to weekday, etc.). If studies were described as double-blind, one point was given, and an additional point was given if blinding was described and appropriate (use of double-dummy, blinded pharmacy manufactured ampoules, etc.), but one point was deducted if blinding was inappropriate. Finally, reports that described the numbers and reasons for withdrawals were given one point. By definition, studies without randomization and blinding were excluded. Thus, the minimum score of an included clinical trial was 2, and the maximum score was 5.
Each trial was assessed for different measures of internal sensitivity. First, trials were checked for magnitude of pain intensity. Because it is difficult to detect an improvement with low or no pain, it was noted if pain scores were less than 30 mm on a visual analog scale (VAS) or less than moderate pain on a verbal rating scale or similar score. 8 Second, it was noted if a power calculation of the statistical tests was performed. Trials with sample sizes less than 10 patients per treatment group were not considered. 9
Use of other intraoperative analgesic treatment (which in theory may preempt pain in the postsurgery treatment group) was noted but not regarded to invalidate the clinical relevance of trials, since common anesthetic practice often includes analgesic use (e.g., intraoperative fentanyl).
Data on postoperative pain and analgesic consumption were extracted for each report. Finally, information about type of anesthesia (general, regional) and number of patients enrolled was taken from each report.
Back to Top | Article Outline
Data Handling
Qualitative analysis of postoperative effectiveness was evaluated by significant difference (P < 0.05 as reported in the original investigation) in pain relief using pain scores, time to first analgesic request, and consumption of supplementary analgesics between the presurgical and postsurgical treatment groups, and by assessment of the clinical importance of observed differences. The plot of L'Abbéet al.9 of VAS pain scores with preemptive versus postsurgical regimens was used as a graphic means of exploring the consistency of efficacy and the homogeneity of the data whenever possible.
Quantitative analysis of combined data were intended by calculation of the weighted mean difference (WMD) of VAS pain scores between treatment groups (using the Review Manager software, version 4.0, the Cochrane Collaboration; The Nordic Cochrane Center, Copenhagen, Denmark). The weight given to each study in this analysis (i.e., how much influence each study had on the overall results) was determined by the precision of its estimate by taking into account study size and SDs of the VAS scores in the individual trials. For the current use, a mean VAS for each treatment group was calculated in every trial from all available recordings performed within 24 h after surgery. Verbal rating pain scores and similar scores were converted to VAS pain scores (e.g., a four-point verbal rating score including no, light, moderate, and severe pain was converted to 0, 25, 50, and 75 mm VAS, respectively). The possibility was recognized that data only would allow a qualitative analysis. Finally, the trials were stratified according to the type of drug (opioid, local anesthetic, N-methyl-d-aspartate [NMDA] receptor antagonist, nonsteroidal antiinflammatory drug [NSAID]), mode of administration (systemic, neuraxial, peripheral nerve block, or wound infiltration), and, if possible, to surgical procedure.
Back to Top | Article Outline

Results

Ninety-three randomized clinical trials of preincisional versus postincisional analgesic regimens for postoperative pain control were identified. Of these, 11 studies were excluded because of lack of appropriate blinding or randomization 10–18 or use of different analgesic doses preoperatively and postoperatively. 19,20 Two articles were not available through the Danish University Library (Copenhagen, Denmark) or the British Library 21,22 (London, United Kingdom), leaving 80 reports for analysis. Studies excluded are summarized in the Appendix.
The remaining studies could be divided into 20 trials of systemic NSAIDs, 8 trials of systemic opioids, 8 trials of systemic NMDA receptor antagonists, 24 trials of epidural, caudal, or intrathecal analgesia, and 20 trials of peripheral local anesthetic use (wound infiltration or nerve block) or combinations of treatment.
Table 1
Table 1
Image Tools
Table 2
Table 2
Image Tools
Table 3
Table 3
Image Tools
Table 4
Table 4
Image Tools
Table 5
Table 5
Image Tools
Table 6
Table 6
Image Tools
Table 7
Table 7
Image Tools
Fig. 1
Fig. 1
Image Tools
Fig. 2
Fig. 2
Image Tools
Fig. 3
Fig. 3
Image Tools
Fig. 4
Fig. 4
Image Tools
A total of 3,761 patients, of which 1,964received preincisional treatment, were studied. The range ofthe number of patients included in the studies was 10(in a crossover trial) to 128. The median quality scorewas 4 (range, 2–5) in trials with significantdifferences in pain relief between the treatment groups and 4(range, 2–5) in trials with no significant differences.The percentage of trials with a significant finding in favor of preemptive analgesia did not differ between trials of high quality (score, 4–5) and trials of lower quality (score, 2–3) (P = 0.67, Fisher test). Details of included studies are shown in tables 1–7 and figures 1–4.
Quantitative analysis was performed on the mean of VAS pain scores recorded within 24 h after surgery for each treatment modality. In five trials, verbal rating scores were converted to VAS scores (two trials of NSAID and three trials of local infiltration). Data on analgesic consumption and time to first analgesic request only allowed a qualitative analysis because of the variety of analgesics, doses, and outcome reporting used. Instead, any statistical difference between treatments regarding these measures was extracted from the original reports and documented in table format as performed previously for other qualitative systematic reviews. 23–25
Back to Top | Article Outline
Acute Postoperative Pain
Nonsteroidal Antiinflammatory Drugs.
Twenty trials comparing preincisional with postincisional NSAID or paracetamol 26 using a parallel or crossover design 26–29 were identified. Various odontologic, abdominal, and orthopedic procedures were studied. The NSAIDs were diclofenac, 27,30–33 naproxen, 28,34 flurbiprofen, 35 ketorolac, 36–42 ketoprofen, 43,44 diflunisal, 29 and ibuprofen 45 used in clinically relevant doses (table 1). Fentanyl, 30,31,33,36,38,39,42–44 alfentanil, 34,37 local anesthetics, 26–29,33,35,45 or nitrous oxide 30,31,36–44 were, as a part of the anesthesia, coadministered intraoperatively in all trials.
In two trials, pain scores were significantly improved immediately after surgery by preemptive compared with postoperative treatment. 36,41 In none of the other trials were improvements observed (fig. 1A). Quantitative analysis with the calculation of the WMD of VAS scores between treatment groups using a fixed-effect model (as test for heterogeneity was nonsignificant, P = 0.78) was not significant (WMD, 0 mm; 95% confidence interval [CI], −2 to 2 mm;fig. 2A) with 14 trials. In the remaining six trials, one of which showed reduced pain scores, 41 there was a lack of dispersion measures for the calculation. 27,31,35,37,41–42
In one trial, 31 the number of patients needing rescue analgesics and time to first request was improved by 28% and 1.5 h, respectively. In two other studies, patient-controlled analgesia–morphine and time to first analgesic request were statistically improved by 6 mg over 6 h 36 and 49 min, 44 respectively. In none of the other trials was demand for supplementary analgesic different between treatment groups.
Power analysis of the statistical tests was only available in five trials, 30,34,36,40,44 with a power of 75–95% of detecting a difference of 15–25 mm VAS at the 5% significance level. Furthermore, intensity of pain scores was low in eight trials (< 30 mm VAS), 27–29,33,35–36,40,45 which might have impaired internal sensitivity.
In conclusion, some aspects of postoperative pain control were improved by preemptive treatment in 4 of the 20 trials. Overall, the data demonstrated preemptive NSAIDs to be of no analgesic benefit when compared with postincisional administration of these drugs.
Back to Top | Article Outline
Intravenous Opioids.
Eight trials with nine treatment arms were identified comparing preincisional with postincisional administration of morphine (10 mg or 0.15–0.3 mg/kg), 46–48 fentanyl (10 μg/kg), 49 alfentanil (40–70 μg/kg), 50,51 sufentanil (1 μg/kg), 49,52 or pentazocine (30–60 mg) 53 (table 2). In all trials, the surgical procedure was abdominal hysterectomy. In none of the trials was other intraoperative analgesics (beside the test drugs) administered except for nitrous oxide in all studies.
In no study were pain scores significantly reduced in the preemptive group (fig. 1B). In contrast, quantitative analysis of pain scores using a fixed-effect model (P = 0.75 in test for heterogeneity) revealed that the WMD in VAS scores between study groups was statistically significant in favor of the postoperative groups (5 mm; 95% CI, 1–9 mm;fig. 2B).
Supplementary analgesic consumption was significantly reduced in two studies in the preemptive group, averaging 10 mg morphine over 24 h 46 and 12 mg morphine 50 from 48 to 72 h, but not from 0 to 6, 6 to 12, 12 to 24, or 24 to 48 h postoperatively, rendering interpretation difficult. Time to first analgesic request was evaluated in only one trial 50 and was not different between study groups.
Intensity of pain scores was considered adequate (> 30 mm VAS) in all trials. However, in only three trials was power analysis of the statistical tests performed, 48–50 revealing an at least 80% power to detect a reduction in VAS scores of 20 mm 49,50 or decrease in opioid consumption of 30%48 at the 5% significance level.
In conclusion, no improvement in postoperative pain control was observed after preemptive administration of systemic opioids.
Back to Top | Article Outline
Intravenous or Intramuscular N-methyl-d-aspartate Receptor Antagonists.
Eight trials were identified comparing preincisional with postincisional ketamine 54–59 or dextromethorphan 60,61 in a variety of surgical procedures (table 3). Ketamine was administered in doses of 0.15–1 mg/kg and in two trials continued with intraoperative infusion of 10 μg · kg−1 · min−1 in the preemptive group, of which one was negative and one positive. 54,56 Dextromethorphan was given in doses of 40 mg to 5 mg/kg (mean, 275 mg). Coadministered analgesic drugs included intraoperative fentanyl, alfentanil, or sufentanil in seven trials 55–61 and nitrous oxide in five trials. 54–58
The worst pain score was significantly reduced by 20 mm VAS in one trial of dextromethorphan. 61 In the seven other trials, no effect on pain scores was observed (fig. 1C). The WMD calculated by use of a random-effect model (P < 0.05 in test for heterogeneity) was not significant (WMD, −2 mm; 95% CI, −8 to 4 mm;fig. 2C).
Supplementary analgesic consumption was significantly reduced by preemptive analgesia in three trials (one ketamine study 54 and the two dextromethorphan trials 60,61) by 40–70%, corresponding to 15–25 mg morphine 54,60 and 57 mg pethidine 61 over a 24–48-h observation period. In the five other trials (of ketamine), no effect 56–59 or increased analgesic consumption 55 was observed compared with the postincisional groups. Time to first analgesic request was evaluated in only one trial and was prolonged by 11 h by preemptive treatment. 61
Power analysis was performed in three trials 55,57,60 and showed an 80% power to detect a difference of 30% or 5 mg/24 h of morphine at the 5% significance level. Intensity of pain scores were greater than 30 mm VAS in all except for one trial. 59
In conclusion, no improvement in postoperative pain control was observed from preemptive systemic ketamine. Both studies on dextromethorphan were positive, but the data are too sparse to reach a definitive conclusion.
Back to Top | Article Outline
Epidural, Caudal or Spinal Regimens.
Eighteen trials of presurgically versus postsurgically initiated epidural analgesic regimens were identified. These could be divided into trials of single-dose analgesic regimens 62–71 and trials of continuous analgesic regimens extending 24–72 h into the postoperative period. 72–79 Furthermore, five trials of caudal analgesia in children 80–84 and one trial of intrathecal anesthesia–analgesia 85 were found eligible for analysis.
Back to Top | Article Outline
Single-dose Epidural Analgesia.
Ten trials with 11 treatment arms were identified comparing different preemptive versus postincisional single-dose epidural analgesic regimens. In four trials, epidural fentanyl (4 μg/kg) 63 and morphine (2–4 mg or 0.05 mg/kg) 65,68,71 were evaluated. In three trials, 64,66–67 epidural bupivacaine (0.5%, 15–20 ml) was studied, in three trials, combined epidural opioid (fentanyl or morphine) and local anesthetic (bupivacaine or mepivacaine), 62,69,71 and in one trial, epidural morphine (2 mg) plus ketamine (60 mg). 70 As a part of a balanced analgesic regimen, systemic NSAID was administered in two studies. 62,67 Coadministered analgesics included intraoperative alfentanil, fentanyl, or morphine in four trials 62,65,58,71 and nitrous oxide in eight trials. 62–66,69–71 Surgical procedures were major thoracic and abdominal (table 4).
Back to Top | Article Outline
Epidural Opioid Regimens.
Pain scores were significantly reduced over 24 h by preemptive analgesia in one trial, 65 but only at six 63 and 18 h, 68 respectively, and not at 2, 4, 8, 10, 24, or 48 h postoperatively in two 63,68 of a total of four trials–treatment arms. 63,65,68,71 Analgesic demand was significantly reduced between 12 and 50%65,68 and by 14 mg of patient-controlled analgesia–morphine from 12–24 h 63 in the preemptive groups in three trials.
Back to Top | Article Outline
Epidural Local Anesthetic Regimens.
Visual analog scale pain scores were not different between study groups in any of three trials. 64,66–67 Patient-controlled analgesia–morphine consumption in the preemptive group was significantly reduced by 16 mg over 24 h in one trial 64 but significantly higher in another trial. 67
Back to Top | Article Outline
Combined Epidural Regimens.
Pain scores were not different between study groups in any of four trials–treatment arms. 62,69–71 Analgesic demand or number of patients requesting analgesics was significantly reduced between 33 and 48% in the preemptive groups in two trials 70,71 but only by 16 mg over 96 h in another trial. 62
Quantitative analysis, which was only possible with seven trials (eight treatment arms) because of lack of dispersion measures, revealed a nonsignificant WMD of mean VAS pain scores recorded over 24 h of −4 mm (95% CI, −9 to 2 mm; random effect mode;P = 0.04 in test for heterogeneity;figs. 3A and 4A). In two of the three trials not included in the WMD calculation, 67–68,70 no significant difference in VAS was observed at any time during the postoperative course supporting the quantitative estimate.
Power analysis of the statistical tests revealing a 90% power was available in two trials, 63,67 although without information of the minimal relevant difference (e.g., number of millimeters VAS), not to be overlooked. Furthermore, in one negative 62 and one positive 68 trial, low pain scores may have impaired internal sensitivity.
In conclusion, the quantitative analysis of mean VAS pain scores showed no significant reduction by preemptive single-dose epidural analgesia with opioid, local anesthetic, or a mixture. However, significant reductions in analgesic demand were demonstrated in 7 of 11 treatment arms.
Back to Top | Article Outline
Continuous Epidural Analgesia.
Eight trials were identified 72–79 comparing different preemptive versus postincisional initiated continuous epidural regimens that extended 24–72 h into the postoperative period.
The regimens investigated included bolus epidural bupivacaine (0.5–0.75%, 8–18 ml) 73–75 plus morphine (2 mg), 74,75 epidural mepivacaine (1.5–2%, 4–15 ml) 76–79 plus morphine (4 mg) 78 or buprenorphine (0.1 mg), 76 and bolus epidural morphine (1.5 mg) plus ketamine (20 mg). 72 These were in the postoperative course followed by continuous epidural bupivacaine (5–10 mg/h) plus morphine (0.2–0.5 mg/h) or fentanyl (10–12 μg/h), 73–75,78,79 epidural mepivacaine (17–60 mg/h) 76,77 plus buprenorphine, and by combined epidural morphine (1 mg), ketamine (10 mg), and lidocaine (32 mg) every 12 h. 72 Coadministered analgesics consisted of fentanyl or alfentanil 73–75,78 and nitrous oxide 72,74–79 in four and seven trials, respectively. The surgical procedures were thoracotomy, major abdominal, and total knee replacement. For details, see table 5.
Visual analog scale pain scores were significantly reduced at certain time points in three trials within the first 72 h, 72,77,79 ranging between 8 and 17 mm on a VAS scale. No differences between groups were observed in the other trials (fig. 3B). Quantitative analysis of WMD of mean VAS scores recorded within 24 h was not significant (WMD, −3 mm; 95% CI, −10 to 5 mm; calculated using a random-effect model as P = 0.0002;fig. 4B). Supplemental patient-controlled analgesia–morphine consumption was significantly reduced by 3 mg over 24 h in only one trial. 72
Intensity of pain scores was considered adequate (> 30 mm VAS) in negative trials 73–76,78 and not a cause of possible insensitivity (although low [< 30 mm VAS] in two of the positive trials). 72,79 Power analysis was performed in only four trials, 73,75,77–78 revealing an 80% power to detect a 12–23-mm difference in VAS at the 5% significance level.
In conclusion, the results showed no overall improvement in postoperative pain relief with preemptive versus postincisional continuous epidural analgesia.
Back to Top | Article Outline
Caudal and Intratheal Analgesia.
Five trials comparing preemptive with postincisional caudal block were identified. 80–84 The analgesics–anesthetics investigated were bupivacaine (0.25%, 0.5–0.8 ml/kg) 80,82–84 plus morphine (0.02 mg/kg), 83 and lidocaine (1%, 0.5 ml/kg). 81 In none of the trials was other intraoperative analgesics administered except for nitrous oxide in all studies. The surgical procedures consisted of hernia repair, orhidopexy, circumcision, and operation for club foot deformities (table 6).
Only in the trial of combined caudal bupivacaine and morphine 83 pain scores and analgesic demand were significantly reduced by the preemptive treatment, ranging 50% and 1 mg of morphine over a 24-h observation period. In no other trials were differences between treatment groups observed. 80–82,84
In one trial, preoperative spinal bupivacaine (15 mg) was compared with an identical postsurgical treatment in patients undergoing abdominal hysterectomy with general anesthesia. 85 No difference in pain scores were observed between treatment groups, but morphine consumption was significantly greater from 0 to 12 h after surgery in the preemptive compared with the postincisional group.
In conclusion, preemptive treatment was ineffective in four of five studies of caudal block and in the one study of intrathecal block.
Back to Top | Article Outline
Peripheral Local Anesthetics.
Twenty trials comparing preemptive with postincisional application of peripheral local anesthetics were found eligible for analysis. These could be divided into trials of wound infiltration, peripheral nerve block, and intraperitoneal infiltration.
Back to Top | Article Outline
Wound Infiltration.
Sixteen trials compared preoperative incisional local anesthetics with similar postincisional administration. 86–101 Bupivacaine (0.25–0.5%), ropivacaine (0.75%), and lidocaine (1–1.5%) were administered in volumes between 4 and 45 ml depending on the extent of the surgical incision and type of procedure. Intraoperative fentanyl or alfentanil and nitrous oxide were coadministered in 10 87–90,92,93,96–98,101 and 13 studies, 86–91,94,95,97–101 respectively. Evaluated surgical procedures were hernia repair, appendectomy, hysterectomy, tonsillectomy, total knee replacement, laparoscopy, breast biopsy, and odontologic surgery (table 7).
Pain scores were significantly reduced 24 h after surgery in the preemptive group in one trial 101 and at certain time points in the postincisional group in two other trials. 93,98 In the other trials, no differences in pain scores between groups were observed (fig. 3C).
Quantitative analysis was only performed with 14 trials because of lack of dispersion measures in the last two trials. 86,92 Using a fixed-effect model (P = 0.29), the WMD of VAS pain scores between treatment groups was nonsignificant (WMD, 0 mm; 95% CI, −3 to 4;fig. 4C).
Analgesic demand was significantly reduced by 50% over a 6-h observation period in one trial, 86 and time to first analgesic request was prolonged by 4 h in another trial 101 in the preemptive compared with the postsurgical treatment groups. In none of the other trials were significant differences observed between study groups.
A number of studies suffered from low internal sensitivity because of low pain scores in either group. 94,95,99 Furthermore, statistical power analysis was only performed in seven of the trials, 86,90,93–97 revealing an 80–90% power of detecting a difference of 10–15 mm VAS. In summary, there is no evidence for improved pain relief with preemptive local anesthetic wound infiltration compared with a similar postincisional administration.
Back to Top | Article Outline
Peripheral Nerve Blocks and Intraperitoneal Local Anesthetic.
Three trials investigated an ilioinguinal iliohypogastric nerve block in patients undergoing cesarean delivery, 102 axillary block in hand or forearm surgery, 103 and intercostal nerve block in patients undergoing thoracotomy. 104 In the latter study, preincisional versus postincisional intravenous morphine and intramuscular diclofenac was coadministered using a multimodal approach 104 (table 7).
No significant difference in pain relief was observed after cesarean section, but results were difficult to interpret because of technical difficulties in obtaining a sufficient block in the preemptive group and because of low pain scores in either group. 102 In the trial of axillary block, postoperative pain and analgesic demand were improved in the postincisional compared with the preemptive group. 103 In contrast, pain scores were reduced during a vital capacity breath test but not at rest, and analgesic demands were not improved by preemptive versus postincisional treatment in the trial of thoracotomy. 104
Finally, pain scores and demand for supplementary ketorolac were reduced by 10 mm VAS and 13 mg, respectively, in the preemptive treatment group from 8 to 24 h after surgery in one trial of topical intraperitoneal 0.5% bupivacaine. 105 In conclusion, the limited data available do not allow conclusions as to a positive effect of preemptive analgesia with peripheral nerve blocks or intraperitoneal local anesthetic.
Back to Top | Article Outline
Chronic Postoperative Pain
Only one study was available comparing preemptive versus postincisional continuous epidural mepivacaine in patients undergoing thoracotomy. 77 Pain scores and the percentages of pain-free patients were improved in the preemptive group at 3 and 6 months after surgery in a fashion parallel to findings on acute pain scores.
Back to Top | Article Outline
Overall Conclusion
Statistical improvements in postoperative pain relief by the preemptive compared with the postincisional treatment were observed in some parameters or time points in 24 of 80 (82 treatment arms) trials. Quantitative analyses of WMD of average VAS pain scores recorded within 24 h after surgery were in no case significant in favor of the preemptive treatment.
The review revealed a lack of evidence for preemptive treatment with NSAIDs, intravenous opioids, intravenous ketamine, peripheral local anesthetics, and caudal analgesia to be of any benefit with respect to postoperative pain relief compared with a similar postincisional treatment. Results from trials of single-dose epidural treatment were inhomogeneous, with more than half of the trials showing statistically significant, but in most cases small, improvements with preemptive analgesia. Results from a third of the trials of continuous epidural analgesia demonstrated, at certain time points, statistically improved pain relief or analgesic demand by preemptive treatment, but overall interpretation of all continuous epidural regimens did not support the hypothesis that preemptive analgesia is of greater benefit than analgesia administered after the onset of the surgical procedure.
Back to Top | Article Outline

Discussion

We tested the clinical evidence for timing of analgesia to improve postoperative pain control in the early and long-term postoperative period in this systematic review. Only trials designed to compare similar preincisional and postincisional treatment were included, excluding a number of studies from the analysis. 19,20 We chose to include a statistical combination of data from the independent trials in a quantitative analysis in addition to the qualitative systematic review. This was done to produce a single estimate of the effect of the intervention and to help resolve disparities between conflicting studies. 106 However, only data on pain scores could be quantitatively analyzed. For the quantitative analysis, we chose to use recordings of average pain scores within the first 24 h postoperatively as we considered this to be a clinically relevant measure and a way to overcome difficulties if only one of several recordings were found significant in an individual study. This analysis may therefore have overlooked potential positive findings within the immediate postoperative period or during the next few postoperative days. With these assumptions, our qualitative and quantitative analysis should be viewed together to achieve an overall synthesis of the results.
A concern was the lack of internal sensitivity and power in some of the negative studies. Validity criteria for the included studies was a number of 10 or more patients per treatment group. 9 Internal sensitivity was evaluated with respect to pain intensity, since it has been recognized that it is difficult to detect an improvement with low or no pain. 8 Furthermore, similar pain scores in study groups receiving active treatment may reflect similar analgesic effects or no effects at all. Inclusion of a placebo group in the comparison would solve the problem with similar or low pain scores. 107 Although pain intensity was low in some trials, and because only rather few trials on preemptive analgesia did include a placebo group, we did not exclude such trials from the analysis, but instead documented studies with low pain scores in the Results and in the tables.
Criticism has previously been raised against a number of negative studies in which both study groups received intraoperative opioid. 108 Such treatment may have caused a similar preemptive effect in both the preoperative and postoperative treatment groups and thereby contributed to the lack of difference in postoperative pain control between groups. Furthermore, various anesthetics have been demonstrated to suppress spinal sensitization in experimental studies. 109 However, such studies have not been excluded from our analysis, since the objective was to investigate if preemptive techniques combined with conventional intraoperative management, which often includes intraoperative opioids or nitrous oxide, can improve postoperative pain control. Although trials were quality assessed, potential pitfalls in individual trials, such as inadequacy of used statistics, may have remained unidentified. Finally, pooling of data from a class of analgesics (e.g., NSAIDs) may blur a possible effect of one specific agent (e.g., ketorolac). However, no such pattern was observed.
A total of 80 trials meeting the strict inclusion and exclusion criteria were identified. The trials were divided into those of NSAIDs, intravenous opioids, parenteral NMDA receptor antagonists, epidural analgesia (single dose or continuous), caudal analgesia, and peripheral local anesthetics. A common feature of the analysis was that timing of analgesia did not influence the quality of postoperative pain control, whatever the type of preemptive analgesia. This conclusion may have clinical relevance. It implies that NSAIDs should not routinely be given preemptively because of the lack of enhanced analgesic effects and because of potential adverse effects such as increased intraoperative bleeding with the preoperative treatment compared with postoperative treatment.
With regard to NMDA receptor antagonists, trials of ketamine were uniformly negative, while the only two existing studies of dextromethorphan were positive of a preemptive effect. Further data are obviously needed to allow a final conclusion as to the clinical recommendation of preemptive treatment with dextromethorphan.
Pain control was, at certain time points, improved by preemptive analgesia in 7 of 11 treatment arms of trials of single-dose epidural analgesia. However, validity and clinical relevance was questionable in several cases and difficult to interpret. Results were therefore considered to reveal a lack of evidence for any important effect (rather than evidence for lack of effect) with preemptive analgesia. Preemptive continuous epidural treatment extending into the postoperative period might theoretically have an improved capacity to reduce nociceptive input and thereby central neuroplasticity caused not only by incision and on-going surgery but also by postsurgical inflammation. However, the results were uniformly negative. In the few studies with improved analgesia, this was only observed at certain time points and not in the overall quantitative analysis. An explanation for the negative findings of continuous epidural regimens may be that, despite continuous treatment, it was insufficient to prevent the development and maintenance of injury-induced central sensitization.
It is widely assumed that preemptive analgesia may reduce the risk of developing chronic postoperative pain. This assumption may be supported by data suggesting that patients with high intensity of acute postoperative pain scores also have a higher risk of developing a chronic pain state. 110 In the only trial to compare the effect of identical preincisional versus postincisional treatment 77 on long-term pain, the percentage of patients with pain at 6 months postoperatively was significantly reduced. Obviously, more data are needed, and in other trials of preemptive treatment versus no treatment in prostatectomy, 20 thoracotomy, 111 or amputation, 112 only one demonstrated an effect on chronic postoperative pain. 20 However, in this study, 20 the follow-up rate was low (65%) and with a diversity between pain and activity scores at the different follow up intervals, making interpretation difficult.
It may be considered surprising and disappointing that the overall conclusion of this systematic review has been negative as to a potential beneficial effect of preemptive analgesia on postoperative pain. The issue of preemptive analgesia for postoperative pain relief has been a topic of several articles and editorials, in which terminology and definition has varied, thereby creating much of the controversy about this concept. 6,108,113 The concept has been further complicated by mixing results from trials of preincisional versus postincisional treatment and trials of pretreatment versus no treatment. 6 A number of suggestions have been offered to explain negative results: outcome measurement problems, too low or too high noxious stimulation induced by the surgical procedure, insufficient afferent blockade–analgesia, insufficient central inhibition, and insufficient duration of the treatment. 6,108,113,114 The current analysis of clinical trials has only focused on one aspect of this discussion, namely, whether timing of conventional analgesic therapy, i.e., preinjury versus postinjury initiation of analgesia, has a clinically significant impact on postoperative pain relief. One conservative conclusion that may be drawn from this review is that there is no need for further trials to investigate the role of timing of preemptive single-dose (short-lasting) analgesic treatment on the postoperative pain pattern. Furthermore, only three of eight trials investigating preemptive continuous epidural treatment extending into the postoperative period demonstrated improved pain relief at certain time points. Thus, overall results are also negative when timing is considered as the variable in prolonged analgesic treatment. It is important to realize, however, that these conclusions do not preclude a possible beneficial effect of an aggressive, perioperative, analgesic intervention on short- and long-term pain after surgery. We suggest that future studies redirect their focus from timing of perioperative analgesia (preemptive analgesia) to protective analgesia, aimed at the prevention of pain hypersensitivity (pathologic pain). These studies should investigate the effects of intensive and prolonged, multimodal analgesic (“protective”) interventions versus less aggressive, conventional perioperative analgesia on immediate and late postoperative pain.
Back to Top | Article Outline

FOOTNOTES

§ Cochrane Library [database online]. Issue 4, 2001. Oxford. Update Software. Updated quarterly. Cited Here...
∥ MEDLINE [database online]. Bethesda: National Library of Medicine. Cited Here...
Back to Top | Article Outline
Appendix:
Table. Appendix Excl...
Table. Appendix Excl...
Image Tools
TABLE Cited Here...
Back to Top | Article Outline

References

1. Woolf CJ: Evidence for a central component of postinjury pain hypersensitivity. Nature 1983; 308: 386–8

2. Coderre TJ, Catz J, Vaccarino AL, Melzack R: Contribution of central neutoplasticity to pathological pain: Review of clinical and experimental evidence. Pain 1993; 52: 259–85

3. Woolf CJ, Chong M-S: Preemptive analgesia: Treating postoperative pain by preventing the establishment of central sensitisation. Anesth Analg 1993; 77: 362–79

4. Dahl JB, Kehlet H: The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth 1993; 70: 434–9

5. McQuay HJ: Pre-emptive analgesia: A systematic review of clinical studies. Ann Med 1995; 27: 249–56

6. Kissin I: Preemptive analgesia. A nesthesiology 2000; 93: 1138–43

7. Jadad AR, Moore A, Carrol D, Jenkinson C, Reynold DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996; 17: 1–12

8. Collins SL, Moore RA, McQuay HJ: The visual analogue pain intensity scale: what is moderate pain in millimeters? Pain 1997; 72: 95–7

9. L'Abbé; K, Detsky AS, O'Rourke K: Meta-analysis in clinical research. Ann Intern Med 1987; 107: 224–33

10. Colbert ST, O'Hanlon DM, McDonnel C, Given FH, Keane PW: Analgesia in day case breast biopsy: The value of pre-emptive tenoxicam. Can J Anaesth 1998; 45: 217–22

11. Murphy DF, Medley C: Preoperative indomethacin for pain relief after thoracotomy: Comparison with postoperative indomethacin. Br J Anaesth 1993; 70: 298–300

12. Mansfield M, Meikle R, Millar C: A trial of pre-emptive analgesia. Influence of timing of peroperative alfentanil on postoperative pain and analgesic requirements. Anaesthesia 1994; 49: 1091–3

13. Wu CT, Yeh CC, Yu JC, Lee MMS, Tao PL, Ho ST, Wong CS: Pre-incisional epidural ketamine, morphine and bupivacaine combined with epidural and general anaesthesia provides pre-emptive analgesia for upper abdominal surgery. Acta Anaesthesiol Scand 2000; 44: 63–8

14. Gunter JB, Forestner JE, Manley CB: Caudal epidural anesthesia reduces blood loss during hypospadias repair. J Urol 1990; 144: 517–9

15. Kucuk N, Kizilkaya M, Tokdemir M: Preoperative epidural ketamine does not have a postoperative opioid sparing effect. Anesth Analg 1998; 87: 103–6

16. Ringrose NH, Cross MJ: Femoral nerve block in knee joint surgery. Am J Sports Med 1984; 12: 398–402

17. Shah R, Sabanathan S, Richardson J, Mearns A, Bembridge J: Continuous paravertebral block for post thoracotomy analgesia in children. J Cardiovasc Surg 1997; 38: 543–6

18. Sakaguchi H, Tashiro T, Koga T, Naomi I, Matsumoto S, Kubota F, Ushijima K, Kano T: Effects of pre- vs postoperative commencement of epidural analgesia on postoperative pain relief and comfort: A study of preemptive analgesia. Kumamoto Med J 1998; 46: 13–20

19. Romej M, Voepel-Lewis T, Merkel SI, Reynolds PI: Effect of preemptive acetaminophen on postoperative pain scores and oral fluid intake in pediatric tonsillectomy patients. AANAJ 1996; 64: 535–40

20. Gottschalk A, Smith DS, Jobes DR, Kennedy SK, Lally SE, Noble VE, Grugan KF, Seifer HA, Cheung A, Malkowitcz B, Gutsche BB, Wein AJ: Preemptive epidural analgesia and recovery from radical prostatectomy: A randomised controlled trial. JAMA 1998; 279: 1076–82

21. Pjevic M, Komarecvic M, Kovacevic S, Jovanovic L, Gajic S: Pre-emptive analgesia in cholecystectomy using pethidine. Med Pregl 1999; 52: 485–8

22. Uckunkaya N, Haci I, Bilgin H, Sahin S: Does clonidine have pre-emptive effects. Agri Dergisi 1995; 7: 17–21

23. Kalso E, Tramèr MR, Carroll D, McQuay HJ, Moore RA: Pain relief from intra-articular morphine after knee surgery: A qualitative systematic review. Pain 1997; 71: 127–34

24. Tramèr MR, Williams JE, Carrol D, Wiffen PJ, Moore RA, McQuay HJ: Comparing analgesic efficacy of non-steroidal anti-inflammatory drugs given by different routes in acute and chronic pain: A qualitative systematic review. Acta Anaesthesiol Scand 1998; 42: 71–9

25. Møiniche S, Mikkelsen S, Wetterslev J, Dahl JB: A qualitative systematic review of incisional local anesthesia for postoperative pain relief after abdominal operations. Br J Anaesth 1998; 81: 377–83

26. Gustafsson I, Nyström E, Quiding H: Effect of preoperative paracetamol on pain after oral surgery. Eur J Clin Pharmacol 1983; 24: 63–5

27. Bridgman JB, Gillgrass TG, Zacharias M: The absence of any pre-emptive analgesic effect for non-steroidal anti-inflammatory drugs. Br J Oral Maxillofac Surg 1996; 34: 428–31

28. Sisk AL, Grover BJ: A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain. J Oral Maxillofac Surg 1990; 48: 674–8

29. Sisk AL, Mosley RO, Martin RP: Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain. J Oral Maxillofac Surg 1989; 47: 464–8

30. Buggy DJ, Wall C, Carton EG: Preoperative or postoperative diclofenac for laparoscopic tubal ligation. Br J Anaesth 1994; 73: 767–70

31. Nordbladh I, Ohlander B, Björkman R: Analgesia in tonsillectomy: A double-blind study on pre and post-operative treatment with diclofenac. Clin Otolaryngol 1991; 16: 554–8

32. Nelson WE, Henderson RC, Almekinders LC, DeMasi RA, Taft TN: An evaluation of pre-and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy: A prospective, randomized, double-blind study. Am J Sport Med 1993; 21: 510–6

33. Sandin R, Sternlo JE, Stam H, Brodd B, Björkman R: Diclofenac for pain relief after arthroscopy: A comparison of early and delayed treatment. Acta Anaesthesiol Scand 1993; 37: 747–50

34. Bünemann L, Thorshauge H, Herlevsen P, Iversen AD, Nielsen FB: Analgesia for outpatient surgery: Placebo versus naproxen sodium (a non-steroidal anti-inflammatory drug) given before or after surgery. Eur J Anaesth 1994; 11: 461–4

35. Flath RK, Hicks ML, Dionne RA, Pelleu GB: Pain suppression after pulpectomy with preoperative flurbiprofen. J Endodontics 1987; 13: 339–47

36. Fletcher D, Zetlaoui P, Monin S, Bombart M, Samii K: Influence of timing on the analgesic effect of intravenous ketorolac after orthopedic surgery. Pain 1995; 61: 291–7

37. Rogers JE, Fleming BG, Macintoch KC, Johnston B, Morgan-Hughes JO: Effect of timing of ketorolac administration on patient-controlled opioid use. Br J Anaesth 1995; 75: 15–8

38. Rømsing J, Østergaard D, Walther-Larsen S, Valentin N: Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy. Acta Anaesthesiol Scand 1998; 42: 770–5

39. Parke TJ, Lowson SM, Uncles DR, Daughtery MO, Sitzman BT: Pre-emptive versus post- surgical administration of ketorolac for hysterectomy. Eur J Anaesthesiol 1995; 12: 549–53

40. Vanlersberghe C, Lauwers, Camu F: Preoperative ketorolac administration has no preemptive analgesic effect for minor orthopaedic surgery. Acta Anaesthesiol Scand 1996; 40: 948–52

41. Peduto VA, Toscano A, D'Uva R, Piga M: Profilassi con ketorolac del dolore acuto postoperatorio. Minerva Anestesiol 1995; 61: 367–72

42. Cabell CA: Does ketorolac produce preemptive analgesic effect in laparoscopic ambulatory surgery patients. AANA J 2000; 68: 343–9

43. Likar R, Krumpholz R, Mathiaschitz K, Pipam W, Burtscher M, Ozegovic G, Breschan C, Bernatzky G, Sittl R: The preemptive action of ketoprofen: Randomized, double-blind study with gynecologic operation. Anaesthesist 1997; 46: 186–90

44. Likar R, Krumpholz, Pipam W, Sadjak A, Kapral S, Forsthuber E, Bernatzky G, List FW: Randomized, double-blind study with ketoprofen in gynecologic patients: Preemptive analgesia study following the Breivik-Stubhaug design. Anaesthesist 1998; 47: 303–10

45. Vogel RI, Desjardins PJ, Major KV: Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain. J Periodontol 1992; 63: 914–8

46. Richmond CE, Bromley LM, Woolf CJ: Preoperative morphine pre-empts postoperative pain. Lancet 1993; 342: 73–5

47. Mansfield MD, James KS, Kinsella J: Influence of dose and timing of administration of morphine on postoperative pain and analgesic requirements. Br J Anaesth 1996; 76: 358–61

48. Millar AY, Mansfield MD, Kinsella J: Influence of timing of morphine administration on postoperative pain and analgesic consumption. Br J Anaesth 1998; 81: 373–6

49. Fassoulaki A, Sarantopoulos C, Zotou M, Papoulia D: Preemptive opioid analgesia does not influence pain after hysterectomy. Can J Anaesth 1995; 42: 109–13

50. Griffin MJ, Hughes D, Knaggs A, Donnelly MB, Boylan JF: Late-onset preemptive analgesia associated with preincisional large-dose alfentanil. Anesth Analg 1999; 85: 1317–21

51. Wilson RJ, Leith S, Jackson IJ, Hunter D: Pre-emptive analgesia from intravenous administration of opioids. Anaesthesia 1994; 49: 591–3

52. Sarantopoulos C, Fassoulaki A: Sufentanil does not preempt pain after abdominal hysterectomy. Pain 1996; 65: 273–6

53. Nagasaka H, Taguchi M, Mizumoto Y, Hori K, Hayashi K, Sugai M, Murakami Y, Oohara K, Matsumoto I, Hori T: Pre-emptive analgesia from intravenous administration of opioid: No effect with pentazocine. Masui 1996; 45: 750–5

54. Fu ES, Miguel R, Scharf JE: Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg 1997; 84: 1086–90

55. Adam F, Libier M, Oszustowicz T, Lefebvre D, Beal J, Meynadier J: Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy. Anesth Analg 1999; 89: 444–7

56. Heinke VW, Grimm D: Präemptive effekte durch ko-analgesie mit ketamin bei gynäkologischen laparotomien? Anesthesiol Reanim 1999; 24: 60–4

57. Menigaux C, Fletcher D, Dupont X, Guinard B, Guirimand F, Chauvin M: The benefit of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg 2000; 90: 129–35

58. Dahl V, Ernoe PE, Steen T, Raeder JC, White PF: Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures? Anesth Analg 2000; 90: 1419–22

59. Mathisen LC, Aasbø;, Ræder J: Lack of pre-emptive analgesic effect of (R)-ketamine in laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1999; 43: 220–4

60. Chia Y, Liu K, Chow L, Lee T: The preoperative administration of intravenous dextromethorphan reduces postoperative morphine consumption. Anesth Analg 1999; 89: 748–52

61. Wu C-T, Yu J-C, Yeh C-C, Liu S-T, Li, C-Y, Ho S-T, Wong C-S: Preincisional dextromethorphan treatment decreases postoperative pain and opioid requirement after laparoscopic cholecystectomy. Anesth Analg 1999; 88: 1331–4

62. Rockemann MG, Seeling W, Bischof C, Börshughaus D, Steffen P, Georgiff M: Prophylactic use of epidural mepivacaine/morphine, systemic diclofenac and metamizole reduces postoperative morphine consumption after major abdominal surgery. A nesthesiology 1996; 84: 1027–34

63. Katz J, Kavanagh BP, Sandler AN, Nierenberg H, Boylan JF, Friedlander M, Shaw BF: Preemptive analgesia: Clinical evidence of neuroplasticity contributing to postoperative pain. A nesthesiology 1992; 77: 439–46

64. Katz J, Clairoux M, Kavanagh BP, Roger S, Nierenberg H, Redahan C, Sandler AN: Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery. Pain 1994; 59: 395–403

65. Kundra P, Gurnani A, Bhattacharya A: Preemptive epidural morphine for postoperative pain relief after lumbar laminectomy. Anesth Analg 1997; 85: 135–8

66. Pryle BJ, Vanner RG, Enriquez N, Reynolds F: Can pre-emptive lumbar epidural blockade reduce postoperative pain following lower abdominal surgery. Anaesthesia 1993; 48: 120–3

67. Espinet A, Henderson DJ, Faccenda KA, Morrison LMM: Does pre-incisional thoracic extradural block combined with diclofenac reduce postoperative pain after abdominal hysterectomy. Br J Anaesth 1996; 76: 209–13

68. Gil GM, Aguado RG, Rosso MT, Alarcón L, Olba FA, Armengod AC, Sanfrancisco JMP, Real FG: Estudio comparativo entre morfina epidural lumbar preventiva o postincisional en cirugía resectiva pulmonar: Informe preliminar. Rev Esp Anesthesiol Reanim 1998; 45: 384–8

69. Richards JT, Read JRM, Chambers WA: Epidural anaesthesia as a method of pre-emptive analgesia for abdominal hysterectomy. Anaesthesia 1998; 53: 296–8

70. Choe H, Choi Y-S, Kim Y-H, Ko S-H, Choi H-G, Han Y-J, Song H-S: Epidural morphine plus ketamine for upper abdominal surgery: Improved analgesia from preincisional administration. Anesth Analg 1997; 84: 560–3

71. Subramaniam B, Pawar DK, Kashyap L: Pre-emptive analgesia with epidural morphine or morphine and bupivacaine. Anaesth Intensive Care 2000; 28: 392–8

72. Wong C-S, Lu C-C, Cherng C-H, Ho S-T: Pre-emptive analgesia with ketamine, morphine and epidural lidocaine prior to total knee replacement. Can J Anaesth 1997; 44: 31–7

73. Aguilar JL, Rincón R, Domingo V, Espachs P, Preciado MJ, Vidal F: Abscence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery. Br J Anaesth 1996; 76: 72–6

74. Dahl JB, Hansen BL, Hjortsø; NC, Ericsen CJ, Møiniche S, Kehlet H: Influence of timing on the effect of continuous extradural analgesia with bupivacaine and morphine after major abdominal surgery. Br J Anaesth 1992; 69: 4–8

75. Dahl JB, Daugaard JJ, Rasmussen B, Egebo K, Carlsson P, Kehlet H: Immediate and prolonged effects of pre- versus postoperative epidural analgesia with bupivacaine and morphine on pain at rest and during mobilisation after total knee arthroplasty. Acta Anaesthesiol Scand 1994; 38: 557–61

76. Nonaka A, Kashimoto S: Does pre-operative epidural buprenorphine improve postoperative pain? Pain Clin 1996; 9: 41–8

77. Obata H, Saito S, Fujita N, Fuse Y, Ishizaki K, Goto F: Epidural block with mepivacaine before surgery reduces long-term post-thoracoctomy pain. Can J Anaesth 1999; 46: 1127–32

78. Flisberg P, Törnebrandt K, Walther B, Lundberg J: A comparison of the effects on postoperative pain relief of epidural analgesia started before or after surgery. Eur J Anaesthesiol 2000; 17: 627–33

79. Nakamura T, Yokoo H, Hamakawa T, Takasaki M: Preemptive analgesia produced with epidural analgesia administered prior to surgery. Masui 1994; 43: 1024–8

80. Rice LJ, Pudimat MA, Hannallah RS: Timing of caudal block placement in relation to surgery does not affect duration of postoperative analgesia in paediatric ambulatory patinets. Can J Anaesth 1990; 37: 429–31

81. Holthausen H, Eichwede F, Stevens M, Willnow U, Lipfert P: Preemptive analgesia: comparison of preoperative with postoperative caudal block on postopertaive pain in children. Br J Anaesth 1994; 73: 440–2

82. Ho JWS, Khambatta HJ, Pang LM, Siegfred RNM, Sun LS: Preemptive analgesia in children: Does it exist. Reg Anesth 1997; 22: 125–30

83. Kundra P, Deepalakshmi K, Ravishankar M: Preemptive caudal bupivacaine and morphine for postoperative analgesia in children. Anesth Analg 1998; 87: 52–6

84. Goodarzi M: The effect of perioperative and postoperative caudal block on pain control in children. Paediatr Anaesth 1996; 6: 475–7

85. Dakin MJ, Osinubi OYO, Carli F: Preoperative spinal bupivacaine does not reduce postoperative morphine requirement in women undergoing total abdominal hysterectomy. Reg Anesth 1996; 21: 99–102

86. Ejlersen E, Andersen H B, Eliasen K, Mogensen T: A comparison between pre- and postincisional lidocaine infiltration on postoperative pain. Anesth Analg 1992; 74: 495–8

87. Dierking G, Dahl J B, Kanstrup J, Dahl Aa, Kehlet H: The effect of pre- versus postoperative inguinal field block on postoperative pain after herniotomy. Br J Anaesth 1992; 68: 344–8

88. Turner GA, Chalkiadis G: Comparison of preoperative with postoperative lignocaine infiltration on postoperative analgesic requirements. Br J Anaesth 1994; 72: 541–3

89. Ørntoft S, Løngren A, Møiniche S, Dahl JB: A comparison of pre- and postoperative tonsillar infiltration with bupivacaine on pain after tonsillectomy: A pre-emptive effect? Anaesthesia 1994; 94: 151–4

90. Victory RA, Gajraj NM, Van Elstraete A, Pace NA, Johnson ER, White PF: Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain. J Clin Anesth 1995; 7: 192–6

91. Dahl V, Ræder JC, Ernø; PE, Kovdal A: Pre-emptive effect of pre-incisional infiltration of local anaesthesia on children undergoing hernioplasty. Acta Anaesthesiol Scand 1996; 40: 847–51

92. Badner NH, Bourne RB, Rorabeck CH, MacDonald SJ, Doyle JA: Intra-articular injection of bupivacaine in knee-replacement operations: Results of use for analgesia and for preemptive blockade. J Bone Joint Surg 1996; 78: 734–8

93. Bourget JL, Clark J, Joy N: Comparing preincisional with postincisional bupivacaine infiltration in the management of postoperative pain. Arch Surg 1997; 132: 766–9

94. Campbell WI, Kendrick RW: Pre-emptive analgesia using local anaesthesia: A study in bilaterally symmetrical surgery. Br J Anaesth 1997; 79: 657–9

95. Campbell WI, Kendrick RW, Ramsay-Baggs P, McCaughey W: The effect of pre-operative administration of bupivacaine compared with its postoperative use. Anaesthesia 1997; 52: 1212–6

96. O'Hanlon DM, Colbert ST, Keane PW, Given FH: Preemptive bupivacaine offers no advantage to postoperative wound infiltration in analgesia for outpatient breast biopsy. Am J Surg 2000; 180: 29–32

97. Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, Auboyer C: Effect of pre- vs postoperative tonsillar infiltration wih local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand 1996; 40: 1210–5

98. Likar R, Morianz U, Wieser S, Schabus H, Spacek A, Koppert W, Sittl R: Präemptive analgesie mit ropivacain bei tonsillektomien im erwachsenealter. Anaesthesist 1999; 48: 373–8

99. Elhakim M, Abdel Hay H: Comparison of preoperative with postoperative topical lidocaine spray on pain after tonsillectomy. Acta Anaesthesiol Scand 1995; 39: 1032–5

100. Podder S, Wig J, Malhotra SK, Sharma S: Effect of pre-emptive analgesia on self-reported and biological measure of pain after tonsillectomy. Eur J Anaesth 2000; 17: 319–4

101. Ke RW, Portera SG, Bagous W, Lincoln SR: A randomized, double-blinded trial of preemptive analgesia in laparoscopy. Obstet Gynecol 1998; 92: 972–5

102. Huffnagle HJ, Norris MC, Leighton BL, Arkoosh VA: Ilioinguinal iliohypogastric nerve blocks: Before or after cesarean delivery under spinal anesthesia? Anesth Analg 1996; 82: 8–12

103. Altintas F, Bozkurt P, Ipek N, Yücel A, Kaya G: The efficacy of pre- versus postsurgically axillary block on postoperative pain in paediatric patients. Paediatr Anaesth 2000; 10: 23–8

104. Doyle E, Bowler GMR: Pre-emptive effect of multimoal analgesia in thoracic surgery. Br J Anaesth 1998; 80: 147–51

105. Pasqualucci A, De Angelis V, Contardo R, Colò; F, Terrosu G, Donini A, Pasetto A, Bresadola F: Preemptive analgesia: Intraperitoneal local anesthetic in laparoscopic cholecystectomy. A nesthesiology 1996; 85: 11–20

106. Jadad AR: Meta-analysis in pain releif: A valuable but easily misused tool. Curr Opin Anaesth 1996; 9: 426–9

107. McQuay HJ, Moore RA: An Evidence-based Resource For Pain Relief. Oxford, Oxford University Press, 1998, pp 14–8

108. Katz J: Pre-emptive analgesia: Evidence, current status and future directions. Eur J Anaesthesiol 1995; 12 (suppl 10): 8–13

109. O'Conner TC, Abram SE: Inhibition of nociception-induced spinal sensitization by anesthetic agents. A nesthesiology 1995; 82: 259–66

110. Perkins F, Kehlet H: Chronic pain as an outcome of surgery: A review of predictive factors. A nesthesiology 2000; 93: 1123–33

111. Katz J, Jackson M, Kavanagh BP, Sandler AN: Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain 1996; 12: 50–5

112. Nikolajsen L, Ilkjær S, Christensen JH, Krøner, K, Jensen TS: Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet 1997; 350: 1353–7

113. Kissin I: Preemptive analgesia: Why its effect is not always obvious. A nesthesiology 1996; 84: 1015–9

114. Dahl JB: Neuronal plasticity and pre-emptive analgesia: Implications for the management of postoperative pain. Dan Med Bull 1994; 41: 434–42

Cited By:

This article has been cited 210 time(s).

Veterinary Journal
Comparison of the effect of intratesticular lidocaine/bupivacaine vs. saline placebo on pain scores and incision site reactions in dogs undergoing routine castration
Stevens, BJ; Posner, LP; Jones, CA; Lascelles, BD
Veterinary Journal, 196(3): 499-503.
10.1016/j.tvjl.2012.11.019
CrossRef
International Journal of Oral and Maxillofacial Surgery
Decreased postoperative pain after reduction of fractured nasal bones using a nerve block of the anterior ethmoidal nerve
Kim, HS; Lee, HK; Jeong, HS; Shin, HW
International Journal of Oral and Maxillofacial Surgery, 42(6): 727-731.
10.1016/j.ijom.2013.01.017
CrossRef
Singapore Medical Journal
Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital
Sin, EIL; Thong, SY; Poon, KH
Singapore Medical Journal, 54(2): 75-81.

Hernia
The effect of preemptive analgesia with bupivacaine on postoperative pain of inguinal hernia repair under spinal anesthesia: a randomized clinical trial
Nesioonpour, S; Akhondzadeh, R; Pipelzadeh, MR; Rezaee, S; Nazaree, E; Soleymani, M
Hernia, 17(4): 465-470.
10.1007/s10029-012-1007-1
CrossRef
Journal of Clinical Anesthesia
Effect of preemptive and preventive acetaminophen on postoperative pain score: a randomized, double-blind trial of patients undergoing lower extremity surgery
Khalili, G; Janghorbani, M; Saryazdi, H; Emaminejad, A
Journal of Clinical Anesthesia, 25(3): 188-192.
10.1016/j.jclinane.2012.09.004
CrossRef
Bmc Medicine
Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review
Ibrahim, MS; Khan, MA; Nizam, I; Haddad, FS
Bmc Medicine, 11(): -.
ARTN 37
CrossRef
Clinical Drug Investigation
Pharmacokinetic Profile of Liposome Bupivacaine Injection Following a Single Administration at the Surgical Site
Hu, D; Onel, E; Singla, N; Kramer, WG; Hadzic, A
Clinical Drug Investigation, 33(2): 109-115.
10.1007/s40261-012-0043-z
CrossRef
Acta Anaesthesiologica Scandinavica
Chronic pain following Caesarean section
Nikolajsen, L; Sorensen, HC; Jensen, TS; Kehlet, H
Acta Anaesthesiologica Scandinavica, 48(1): 111-116.

Drugs
What is the role of NSAIDs in pre-emptive analgesia?
Ochroch, EA; Mardini, IA; Gottschalk, A
Drugs, 63(): 2709-2723.

Molecular Pain
Pre-injury administration of morphine prevents development of neuropathic hyperalgesia through activation of descending monoaminergic mechanisms in the spinal cord in mice
Rashid, MH; Ueda, H
Molecular Pain, 1(): -.
ARTN 19
CrossRef
Anaesthesist
Non-opioid analgesics for perioperative pain therapy. Risks and rational basis for application
Brack, A; Rittner, HL; Schafer, M
Anaesthesist, 53(3): 263-280.
10.1004/s00101-003-0641-5
CrossRef
Journal of Feline Medicine and Surgery
Pain management in cats - past, present and future. Part 1. The cat is unique
Taylor, PM; Robertson, SA
Journal of Feline Medicine and Surgery, 6(5): 313-320.
10.1016/j.jfms.2003.10.003
CrossRef
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics
A prospective randomized crossover study of the preemptive analgesic effect of nitrous oxide in oral surgery
Ong, KS; Seymour, RA; Tan, JML
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, 98(6): 637-642.
10.1016/j.tripleo.2004.02.078
CrossRef
Anesthesia and Analgesia
The role of the anesthesiologist in fast-track surgery: From multimodal analgesia to perioperative medical care
White, PF; Kehlet, H; Neal, JM; Schricker, T; Carr, DB; Carli, F
Anesthesia and Analgesia, 104(6): 1380-1396.
10.1213/01.ane.0000263034.96885.e1
CrossRef
Minerva Anestesiologica
Analgesia before, during and after surgery: prevention of postoperative pain
Maisano, P; Ingelmo, PM
Minerva Anestesiologica, 73(): 613-614.

Douleur Et Analgesie
Evidence-based medicine and practice guidelines: translating clinical research results into patient care
Fervers, B
Douleur Et Analgesie, 20(2): 73-77.
10.1007/s11724-007-0042-7
CrossRef
Medical Science Monitor
Combined vs. Isoflurane/Fentanyl anesthesia for major abdominal surgery: Effects on hormones and hemodynamics
Goldmann, A; Hoehne, C; Fritz, GA; Unger, J; Ahlers, O; Nachtigall, I; Boemke, W
Medical Science Monitor, 14(9): CR445-CR452.

Neuroendocrinology Letters
Preemptive levetiracetam decreases postoperative pain in rats
Sliva, J; Dolezal, T; Prochazkova, M; Votava, M; Krsiak, M
Neuroendocrinology Letters, 29(6): 953-957.

Urologe
Preoperative pain in urological patients scheduled for surgical intervention. Incidence, severity and chronicity
Ozgur, E; Straub, K; Dagtekin, O; Engelmann, U; Heidenreich, A; Gerbershagen, HJ
Urologe, 48(8): 894-900.
10.1007/s00120-009-2001-9
CrossRef
Anesthesia and Analgesia
Prolonged differential wound hyperalgesia after an interval of unilateral epidural blockade during lower abdominal surgery
Gottschalk, A; Frank, SM
Anesthesia and Analgesia, 100(5): 1411-1413.
10.1213/01.ANE.0000150608.78242.1A
CrossRef
Pain
Neuropathic pain: Early spontaneous afferent activity is the trigger
Xie, WR; Strong, JA; Meij, JTA; Zhang, JM; Yu, L
Pain, 116(3): 243-256.
10.1016/j.pain.2005.04.017
CrossRef
American Journal of Health-System Pharmacy
Postoperative pain management: A practical review, part 1
Strassels, SA; McNicol, E; Suleman, R
American Journal of Health-System Pharmacy, 62(): 1904-1916.
10.2146/ajhp040490.p1
CrossRef
Surgical Endoscopy and Other Interventional Techniques
A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy
Kehlet, H; Gray, AW; Bonnet, F; Camu, F; Fischer, HBJ; McCloy, RF; Neugebauer, EAM; Puig, MM; Rawal, N; Simanski, CJP
Surgical Endoscopy and Other Interventional Techniques, 19(): 1396-1415.
10.1007/s00464-004-2173-8
CrossRef
Anasthesiologie & Intensivmedizin
The role of peripheral and central sensitisation in the maintenance and development of postoperative pain
Pogatzki-Zahn, EM
Anasthesiologie & Intensivmedizin, 47(): 638-+.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery
White, PF; Sacan, O; Tufanogullari, B; Eng, M; Nuangchamnong, N; Ogunnaike, B
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 54(5): 342-348.

British Journal of Anaesthesia
Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery
Gottschalk, A; Freitag, M; Steinacker, E; Kreissl, S; Rempf, C; Staude, HJ; Strate, T; Standl, T
British Journal of Anaesthesia, 100(1): 36-41.
10.1093/bja/aem338
CrossRef
Acta Anaesthesiologica Scandinavica
The ketamine enigma
Persson, J
Acta Anaesthesiologica Scandinavica, 52(4): 453-455.
10.1111/j.1399-6576.2008.01621.x
CrossRef
Anesthesia and Analgesia
Low-Dose Systemic Bupivacaine Prevents the Development of Allodynia After Thoracotomy in Rats
Shin, JW; Pancaro, C; Wang, CF; Gerner, P
Anesthesia and Analgesia, 107(5): 1587-1591.
10.1213/ane.0b013e31818200aa
CrossRef
Urologe
Postoperative pain therapy after radical prostatectomy with and without epidural analgesia
Ozgur, E; Dagtekin, O; Straub, K; Engelmann, U; Gerbershagen, HJ
Urologe, 48(): 1182-1188.
10.1007/s00120-009-2039-8
CrossRef
Lancet
Anaesthesia, surgery, and challenges in postoperative recovery
Kehlet, H; Dahl, JB
Lancet, 362(): 1921-1928.

Life Sciences
Preemptive effects of intrathecal cyclooxygenase inhibitor or nitric oxide synthase inhibitor on thermal hypersensitivity following peripheral nerve injury
Lui, PW; Lee, CH
Life Sciences, 75(): 2527-2538.
10.1016/j.lfs.2004.04.033
CrossRef
Journal of Clinical Psychiatry
Preemptive analgesia: Is pain less costly when you pre-pay for it?
Stahl, SM
Journal of Clinical Psychiatry, 65(): 1591-1592.

Pain
Ketamine and postoperative pain - a quantitative systematic review of randomised trials
Elia, N; Tramer, MR
Pain, 113(): 61-70.
10.1016/j.pain.2004.09.036
CrossRef
Anesthesia and Analgesia
Intrathecal and epidural anesthesia and analgesia for cardiac surgery
Chaney, MA
Anesthesia and Analgesia, 102(1): 45-64.
10.1213/01.ane.0000183650.16038.f6
CrossRef
Current Therapeutic Research-Clinical and Experimental
Comparison of preemptive analgesic effects of a single dose of nonopioid analgesics for pain management after ambulatory surgery: A prospective, randomized, single-blind study in Turkish patients
Sener, M; Pektas, ZO; Yilmaz, I; Turkoz, A; Uckan, S; Donmez, A; Arslan, G
Current Therapeutic Research-Clinical and Experimental, 66(6): 541-551.
10.1016/j.curtheres.2005.12.001
CrossRef
Acta Anaesthesiologica Scandinavica
A qualitative systematic review of peri-operative dextromethorphan in post-operative pain
Duedahl, TH; Romsing, J; Moiniche, S; Dahl, JB
Acta Anaesthesiologica Scandinavica, 50(1): 1-13.
10.1111/j.1399-6576.2005.00900.x
CrossRef
Journal of Pain
The intravenous ketamine test predicts subsequent response to an oral dextromethorphan treatment regimen in fibromyalgia patients
Cohen, SP; Verdolin, MH; Chang, AS; Kurihara, C; Morlando, BJ; Mao, JR
Journal of Pain, 7(6): 391-398.
10.1016/j.jpain.2005.12.010
CrossRef
Journal of Veterinary Pharmacology and Therapeutics
Postoperative analgesia in dogs receiving epidural morphine plus medetomidine
Pacharinsak, C; Greene, SA; Keegan, RD; Kalivas, PW
Journal of Veterinary Pharmacology and Therapeutics, 26(1): 71-77.

Danish Medical Bulletin
Inguinal hernia repair: anaesthesia, pain and convalescence
Callesen, T
Danish Medical Bulletin, 50(3): 203-218.

Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
New insights in postoperative pain therapy
Brack, A; Bottiger, BW; Schafer, M
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 39(3): 157-164.
10.1055/s-2004-814314
CrossRef
Anesthesia and Analgesia
Persistent pain as a disease entity: Implications for clinical management
Siddall, PJ; Cousins, MJ
Anesthesia and Analgesia, 99(2): 510-520.
10.1213/01.ANE.0000133383.17666.3A
CrossRef
Acta Anaesthesiologica Scandinavica
Analgesic effects of preincisional administration of dextromethorphan and tenoxicam following laparoscopic cholecystectomy
Yeh, CC; Wu, CT; Lee, MS; Yu, JC; Yang, CP; Lu, CH; Wong, CS
Acta Anaesthesiologica Scandinavica, 48(8): 1049-1053.
10.1111/j.1399-6576.2004.00455.x
CrossRef
British Journal of Anaesthesia
Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes
Ozyalcin, NS; Yucel, A; Camlica, H; Dereli, N; Andersen, OK; Arendt-Nielsen, L
British Journal of Anaesthesia, 93(3): 356-361.
10.1093/bja/aeh220
CrossRef
Anesthesia and Analgesia
The changing role of non-opioid analgesic techniques in the management of postoperative pain
White, PF
Anesthesia and Analgesia, 101(5): S5-S22.

Pediatric Anesthesia
Effect of an intravenous single dose of ketamine on postoperative pain in tonsillectomy patients
Da Conceicao, MJ; Da Conceicao, DB; Leao, CC
Pediatric Anesthesia, 16(9): 962-967.
10.1111/j.1460-9592.2006.01893.x
CrossRef
Journal of Neurophysiology
Sympathetic sprouting near sensory neurons after nerve injury occurs preferentially on spontaneously active cells and is reduced by early nerve block
Xie, WR; Strong, JA; Li, HQ; Zhang, JM
Journal of Neurophysiology, 97(1): 492-502.
10.1152/jn.00899.2006
CrossRef
Ophthalmology
Preoperative sub-Tenon's capsule injection of ropivacaine in conjunction with general anesthesia in retinal detachment surgery
Bergman, L; Backmark, I; Ones, H; von Euler, C; Olivestedt, G; Kvanta, A; Steen, B; Seregard, S; Nilsson, B; Berglin, L
Ophthalmology, 114(): 2055-2060.
10.1016/j.ophtha.2006.12.031
CrossRef
Auris Nasus Larynx
Pre-emptive analgesia for removal of nasal packing: A double-blind placebo controlled study
Yilmazer, C; Sener, M; Yilmaz, I; Erkan, AN; Cagici, CA; Donmez, A; Arslan, G; Ozluoglu, LN
Auris Nasus Larynx, 34(4): 471-475.
10.1016/j.anl.2006.11.013
CrossRef
British Journal of Anaesthesia
Preventive effects of perioperative parecoxib on post-discectomy pain
Riest, G; Peters, J; Weiss, M; Dreyer, S; Klassen, PD; Stegen, B; Bello, A; Eikermann, M
British Journal of Anaesthesia, 100(2): 256-262.
10.1093/bja/aem345
CrossRef
Acta Anaesthesiologica Scandinavica
Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for inguinal herniorrhaphy
Toivonen, J; Permi, J; Rosenberg, PH
Acta Anaesthesiologica Scandinavica, 48(4): 480-485.
10.1111/j.1399-6576.2004.00346.x
CrossRef
Javma-Journal of the American Veterinary Medical Association
Prevalence and characteristics of pain in dogs and cats examined as outpatients at a veterinary teaching hospital
Muir, WW; Wiese, AJ; Wittum, TE
Javma-Journal of the American Veterinary Medical Association, 224(9): 1459-1463.

Anaesthesist
Opioid-induced hyperalgesia. Pathophysiology and clinical relevance
Koppert, W
Anaesthesist, 53(5): 455-466.

Anesthesia and Analgesia
The intravenous ketamine test: A predictive response tool for oral dextromethorphan treatment in neuropathic pain
Cohen, SP; Chang, AS; Larkin, T; Mao, JR
Anesthesia and Analgesia, 99(6): 1753-1759.
10.1213/01.ANE.0000136953.11583.7B
CrossRef
Pain
Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model
Koppert, W; Ihmsen, H; Korber, N; Wehrfritz, A; Sittl, R; Schmelz, M; Schuttler, J
Pain, 118(): 15-22.
10.1016/j.pain.2005.06.030
CrossRef
Iranian Red Crescent Medical Journal
Preemptive Effects of Lidocain on Postoperative Pain in Patients Undergoing Disc Operation: A Randomized, Double Blind, Placebo-Controlled Clinical Trial
Fakharian, E; Fazel, MR; Tabesh, H; Masoud, SA
Iranian Red Crescent Medical Journal, 11(1): 37-41.

Anz Journal of Surgery
Post-surgical neuropathic pain
Shipton, E
Anz Journal of Surgery, 78(7): 548-555.
10.1111/j.1445-2197.2008.04569.x
CrossRef
Anesthesia and Analgesia
An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery
Lavand'homme, PM; Roelants, F; Waterloos, H; COllet, V; De Kock, MF
Anesthesia and Analgesia, 107(3): 948-955.
10.1213/ane.0b013e31817f1595
CrossRef
Schmerz
Pain and quality of life for living donors after nephrectomy
Gottschalk, A; Gotz, J; Zenz, M
Schmerz, 23(5): 502-509.
10.1007/s00482-009-0803-8
CrossRef
British Journal of Anaesthesia
Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression
Kotze, A; Scally, A; Howell, S
British Journal of Anaesthesia, 103(5): 626-636.
10.1093/bja/aep272
CrossRef
Regional Anesthesia and Pain Medicine
Mechanisms for pain caused by incisions
Zahn, PK; Pogatzki, EM; Brennan, TJ
Regional Anesthesia and Pain Medicine, 27(5): 514-516.
10.1053/rapm.2002.35155
CrossRef
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Anesthesia in thoracic surgery
Wiedemann, K; Mannle, C; Layer, M; Herth, F
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 39(): 616-650.
10.1055/s-2004-825978
CrossRef
Pharmacotherapy
Making progress in the management of postoperative pain: A review of the cyclooxygenase 2-specific inhibitors
Stephens, JM; Pashos, CL; Haider, S; Wong, JM
Pharmacotherapy, 24(): 1714-1731.

Javma-Journal of the American Veterinary Medical Association
Prevention of central sensitization and pain by N-methyl-D-aspartate receptor antagonists
Pozzi, A; Muir, WW; Traverso, F
Javma-Journal of the American Veterinary Medical Association, 228(1): 53-60.

Proceedings of the 8th Biennial Congress of the Asian & Oceanic Society of Regional Anesthesia and Pain Medicine
Pre-emptive analgesia
Scott, DA
Proceedings of the 8th Biennial Congress of the Asian & Oceanic Society of Regional Anesthesia and Pain Medicine, (): 43-45.

Acta Anaesthesiologica Scandinavica
Bowel function after bowel surgery: morphine with ketamine or placebo; a randomized controlled trial pilot study
Mckay, WP; Donais, P
Acta Anaesthesiologica Scandinavica, 51(9): 1166-1171.
10.1111/j.1399-6576.2007.01436.x
CrossRef
European Journal of Cancer
A review of the literature on post-operative pain in order cancer patients
Looi, YC; Audisio, RA
European Journal of Cancer, 43(): 2222-2230.
10.1016/j.ejca.2007.08.003
CrossRef
Javma-Journal of the American Veterinary Medical Association
Evaluation of epidural administration of morphine or morphine and bupivacaine for postoperative analgesia after premedication with an opioid analgesic and orthopedic surgery in dogs
Kona-Boun, JJ; Cuvelliez, S; Troncy, E
Javma-Journal of the American Veterinary Medical Association, 229(7): 1103-1112.

Journal of Molecular Neuroscience
Effect of gabapentin on c-Fos expression in the CNS after paw surgery in rats
Kazi, JA; Gee, CF
Journal of Molecular Neuroscience, 32(3): 228-234.
10.1007/s12031-007-0048-x
CrossRef
European Journal of Cardio-Thoracic Surgery
Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention
Wildgaard, K; Ravn, J; Kehlet, H
European Journal of Cardio-Thoracic Surgery, 36(1): 170-180.
10.1016/j.ejcts.2009.02.005
CrossRef
European Journal of Cardio-Thoracic Surgery
A prospective study of analgesic quality after a thoracotomy: paravertebral block with ropivacaine before and after rib spreading
Fibla, JJ; Molins, L; Mier, JM; Sierra, A; Vidal, G
European Journal of Cardio-Thoracic Surgery, 36(5): 901-905.
10.1016/j.ejcts.2009.05.041
CrossRef
Progres En Urologie
Effect of wound infiltration of ropivacaine in postoperative pain after extraperitoneal laparoscopic radical prostatectomy
Berthon, N; Plainard, X; Cathelineau, X; Rozet, F; Cathala, N; Mombet, A; Galiano, M; Prapotnich, D; Barret, E; Vallancien, G
Progres En Urologie, 20(6): 435-439.
10.1016/j.purol.2009.12.003
CrossRef
Anesthesia and Analgesia
A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia
McCartney, CJL; Sinha, A; Katz, J
Anesthesia and Analgesia, 98(5): 1385-1400.
10.1213/01.ANE.0000108501.57073.38
CrossRef
Anaesthesist
Anesthesia and analgesia in addicts
Jage, J; Heid, F
Anaesthesist, 55(6): 611-+.
10.1007/s00101-006-1012-9
CrossRef
Orthopade
Perioperative pain management in orthopaedics
Schulz, A; Jerosch, J
Orthopade, 36(1): 32-+.
10.1007/s00132-006-1026-7
CrossRef
International Journal of Oral and Maxillofacial Surgery
A comparison of pre-emptive analgesic efficacy of diflunisal and lornoxicam for postoperative pain management: a prospective, randomized, single-blind, crossover study
Pektas, ZO; Sener, M; Bayram, B; Eroglu, T; Bozdogan, N; Donmez, A; Arslan, G; Uckan, S
International Journal of Oral and Maxillofacial Surgery, 36(2): 123-127.
10.1016/j.ijom.2006.10.005
CrossRef
European Journal of Obstetrics Gynecology and Reproductive Biology
Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management
Lowenstein, L; Zimmer, EZ; Deutsch, M; Paz, Y; Yaniv, D; Jakobi, P
European Journal of Obstetrics Gynecology and Reproductive Biology, 136(2): 239-242.
10.1016/j.ejogrb.2006.11.008
CrossRef
Vlaams Diergeneeskundig Tijdschrift
Perioperative pain: physiology and pathophysiology
Bosmans, T; Doom, M; Gasthuys, F; Simoens, P; Van Ham, L; Polis, I
Vlaams Diergeneeskundig Tijdschrift, 78(5): 302-313.

Pediatric Anesthesia
A pilot study of the rectus sheath block for pain control after umbilical hernia repair
Isaac, LA; McEwen, J; Hayes, JA; Crawford, MW
Pediatric Anesthesia, 16(4): 406-409.
10.1111/j.1460-9592.2005.01785.x
CrossRef
American Journal of Veterinary Research
Evaluation of intravenous administration of meloxicam for perioperative pain management following stifle joint surgery in dogs
Budsberg, SC; Cross, AR; Quandt, JE; Pablo, LS; Runk, AR
American Journal of Veterinary Research, 63(): 1557-1563.

Urologia Internationalis
Patient-controlled epidural analgesia after major urologic surgeries
Aribogan, A; Doruk, N; Aridogan, A; Akin, S; Balcioglu, O
Urologia Internationalis, 71(2): 168-175.
10.1159/000071841
CrossRef
Veterinary Surgery
Analgesic comparison of meloxicam or ketoprofen for orthopedic surgery in dogs
Deneuche, AJ; Dufayet, C; Goby, L; Fayolle, P; Desbois, C
Veterinary Surgery, 33(6): 650-660.
10.1111/j.1532-950X.2004.04088.x
CrossRef
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Pharmacological PONV-control: Prevention or treatment
Tramer, MR
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 40(8): 493-497.
10.1055/s-2005-861336
CrossRef
Annals of Thoracic Surgery
Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy
Detterbeck, FC
Annals of Thoracic Surgery, 80(4): 1550-1559.
10.1016/j.athoracsur.2004.11.051
CrossRef
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Pain management after ambulatory' surgery - Where is the disconnect?
White, PF
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 55(4): 201-207.

Australian Veterinary Journal
Effects of meloxicam or tolfenamic acid administration on the pain and stress responses of Merino lambs to mulesing
Paull, DR; Lee, C; Atkinson, SJ; Fisher, AD
Australian Veterinary Journal, 86(8): 303-311.
10.1111/j.1751-0813.2008.00325.x
CrossRef
Acta Anaesthesiologica Scandinavica
Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomy
Tauzin-Fin, P; Sesay, M; Svartz, L; Krol-Houdek, MC; Maurette, P
Acta Anaesthesiologica Scandinavica, 53(4): 464-469.
10.1111/j.1399-6576.2008.01888.x
CrossRef
Anaesthesia Pain Intensive Care and Emergency Medicine - A.P.I.C.E, Vol 1 and 2
Pain relief by ketamine
Himmelseher, S; Kochs, E
Anaesthesia Pain Intensive Care and Emergency Medicine - A.P.I.C.E, Vol 1 and 2, (): 903-913.

New Zealand Veterinary Journal
Current attitudes to, and use of, peri-operative analgesia in dogs and cats by veterinarians in New Zealand
Williams, VM; Lascelles, BDX; Robson, MC
New Zealand Veterinary Journal, 53(3): 193-202.

British Journal of Anaesthesia
Low dose of S(+)-ketamine prevents long-term potentiation in pain pathways under strong opioid analgesia in the rat spinal cord in vivo
Benrath, J; Brechtel, C; Sandkuhler, J
British Journal of Anaesthesia, 95(4): 518-523.
10.1093/bja/aei215
CrossRef
Regional Anesthesia and Pain Medicine
A Preoperative retrobulbar block in patients undergoing scleral buckling reduces pain, endogenous stress response, and improves vigilance
Vogt, G; Heiden, M; Losche, CC; Lipfert, P
Regional Anesthesia and Pain Medicine, 28(6): 521-527.
10.1016/j.rapm.2003.09.004
CrossRef
Annales Francaises D Anesthesie Et De Reanimation
Low doses ketamine: antihyperalgesic drug, non-analgesic
Richebe, P; Rivat, C; Rivalan, B; Maurette, P; Simonnet, G
Annales Francaises D Anesthesie Et De Reanimation, 24(): 1349-1359.
10.1016/j.annfar.2005.07.069
CrossRef
Anesthesia and Analgesia
The efficacy of thoracic epidural neostigmine infusion after thoracotomy
Chia, YY; Chang, TH; Liu, K; Chang, HC; Ko, NH; Wang, YM
Anesthesia and Analgesia, 102(1): 201-208.
10.1213/01.ane.0000184812.94185.b3
CrossRef
British Journal of Anaesthesia
Premedication with controlled-release oxycodone does not improve management of postoperative pain after day-case gynaecological laparoscopic surgery
Jokela, R; Ahonen, J; Valjus, M; Seppala, T; Korttila, K
British Journal of Anaesthesia, 98(2): 255-260.
10.1093/bja/ael342
CrossRef
Veterinary Anaesthesia and Analgesia
Nonsteroidal anti-inflammatory drugs in cats: a review
Duncan, B; Lascelles, X; Court, MH; Hardie, EM; Robertson, SA
Veterinary Anaesthesia and Analgesia, 34(4): 228-250.
10.1111/j.1467-2995.2006.00322.x
CrossRef
Veterinary Journal
Pain mechanisms and their implication for the management of pain in farm and companion animals
Vinuela-Fernandez, I; Jones, E; Welsh, EM; Fleetwood-Walker, SM
Veterinary Journal, 174(2): 227-239.
10.1016/j.tvjl.2007.02.002
CrossRef
Journal of Clinical Anesthesia
The influence of timing of systemic ketamine administration on postoperative morphine consumption
Bilgin, H; Ozcan, B; Bilgin, T; Kerimoglu, B; Uckunkaya, N; Toker, A; Alev, T; Osma, S
Journal of Clinical Anesthesia, 17(8): 592-597.
10.1016/j.jclinane.2005.04.005
CrossRef
Acta Obstetricia Et Gynecologica Scandinavica
Effect of presurgical local infiltration of levobupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecological surgery
Alessandri, F; Lijoi, D; Mistrangelo, E; Nicoletti, A; Ragni, N
Acta Obstetricia Et Gynecologica Scandinavica, 85(7): 844-849.
10.1080/00016340500494846
CrossRef
Anasthesiologie & Intensivmedizin
Spinal mechanisms of postoperative pain
Zahn, PK
Anasthesiologie & Intensivmedizin, 47(): 517-527.

Journal of Bone and Joint Surgery-American Volume
Preventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques
Reuben, SS; Buvanendran, A
Journal of Bone and Joint Surgery-American Volume, 89A(6): 1343-1358.

Current Opinion in Investigational Drugs
Multimodal analgesia: Its role in preventing postoperative pain
White, PF
Current Opinion in Investigational Drugs, 9(1): 76-82.

Anaesthesist
Drugs for postoperative analgesia: routine and new aspects. Part1: Non-opioids
Jage, J; Laufenberg-Feldmann, R; Heid, F
Anaesthesist, 57(4): 382-+.
10.1007/s00101-008-1326-x
CrossRef
Minerva Anestesiologica
Updating postoperative pain management: from multimodal to context-sensitive treatment
Fanelli, G; Berti, M; Baciarello, M
Minerva Anestesiologica, 74(9): 489-500.

Annals of Thoracic Surgery
Acute pain management for patients undergoing thoracotomy
Soto, RG; Fu, ES
Annals of Thoracic Surgery, 75(4): 1349-1357.
PII S0003-4975(02)04647-7
CrossRef
Acta Anaesthesiologica Scandinavica
Influence of the cortical electrical activity level during general anaesthesia on the severity of immediate postoperative pain in the morbidly obese
Gurman, GM; Popescu, M; Weksler, N; Steiner, O; Avinoah, E; Porath, A
Acta Anaesthesiologica Scandinavica, 47(7): 804-808.

British Medical Bulletin
Pre-emptive analgesia
Dahl, JB; Moiniche, S
British Medical Bulletin, 71(1): 13-27.
10.1093/bmb/ldh030
CrossRef
Clinical Nutrition
Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection
Fearon, KCH; Ljungqvist, O; Von Meyenfeldt, M; Revhaug, A; Dejong, CHC; Lassen, K; Nygren, J; Hausel, J; Soop, M; Andersen, J; Kehlet, H
Clinical Nutrition, 24(3): 466-477.
10.1016/j.clnu.2005.02.002
CrossRef
British Journal of Anaesthesia
Chronic postoperative pain: the case of inguinal herniorrhaphy
Aasvang, E; Kehlet, H
British Journal of Anaesthesia, 95(1): 69-76.
10.1093/bja/aei019
CrossRef
Journal of Arthroplasty
The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty
Peters, CL; Shirley, B; Erickson, J
Journal of Arthroplasty, 21(6): 132-138.
10.1016/j.arth.2006.04.017
CrossRef
Anesthesia and Analgesia
The influence of timing of administration on the analgesic efficacy of parecoxib in orthopedic surgery
Martinez, V; Belbachir, A; Jaber, A; Cherif, K; Jamal, A; Ozier, Y; Sessler, DI; Chauvin, M; Fletcher, D
Anesthesia and Analgesia, 104(6): 1521-1527.
10.1213/01.ane.0000262039.69513.9d
CrossRef
Current Opinion in Investigational Drugs
Multimodal pain management - The future is now!
White, PF
Current Opinion in Investigational Drugs, 8(7): 517-518.

Pediatric Anesthesia
The preventative analgesic effect of preincisional peritonsillar infiltration of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy. A randomized, double-blind, placebo-controlled study
Honarmand, A; Safavi, MR; Jamshidi, M
Pediatric Anesthesia, 18(6): 508-514.
10.1111/j.1460-9592.2008.02461.x
CrossRef
Anesthesia and Analgesia
Postoperative ketamine administration decreases morphine consumption in major abdominal surgery: A prospective, randomized, double-blind, controlled study
Zakine, J; Samarcq, D; Lorne, E; Moubarak, M; Montravers, P; Beloucif, S; Dupont, H
Anesthesia and Analgesia, 106(6): 1856-1861.
10.1213/ane.0b013e3181732776
CrossRef
Australian Journal of Experimental Agriculture
Effectiveness of non-steroidal anti-inflammatory drugs and epidural anaesthesia in reducing the pain and stress responses to a surgical husbandry procedure (mulesing) in sheep
Paull, DR; Colditz, IG; Lee, C; Atkinson, SJ; Fisher, AD
Australian Journal of Experimental Agriculture, 48(): 1034-1039.
10.1071/EA08050
CrossRef
Journal of the American Academy of Dermatology
An analysis of pain and analgesia after Mohs micrographic surgery
Firoz, BF; Goldberg, LH; Arnon, O; Mamelak, AJ
Journal of the American Academy of Dermatology, 63(1): 79-86.
10.1016/j.jaad.2009.10.049
CrossRef
Acta Anaesthesiologica Scandinavica
'Protective premedication': an option with gabapentin and related drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain
Dahl, JB; Mathiesen, O; Moiniche, S
Acta Anaesthesiologica Scandinavica, 48(9): 1130-1136.
10.1111/j.1399-6576.2004.00484.x
CrossRef
Canadian Veterinary Journal-Revue Veterinaire Canadienne
Understanding the pathophysiology of perioperative pain
Lemke, KA
Canadian Veterinary Journal-Revue Veterinaire Canadienne, 45(5): 405-413.

Polish Journal of Pharmacology
Influence of pre-operative ketoprofen administration (preemptive analgesia) on analgesic requirement and the level of prostaglandins in the early postoperative period
Wnek, W; Zajaczkowska, R; Wordliczek, J; Dobrogowski, J; Korbut, R
Polish Journal of Pharmacology, 56(5): 547-552.

Anesthesia and Analgesia
Update on acute pain management
Rowlingson, JC
Anesthesia and Analgesia, (): 95-106.

Lancet
Persistent postsurgical pain: risk factors and prevention
Kehlet, H; Jensen, TS; Woolf, CJ
Lancet, 367(): 1618-1625.

Clinical Drug Investigation
Premedication with Sublingual Morphine Sulphate in Abdominal Surgery
Campiglia, L; Cappellini, I; Consales, G; Borracci, T; Vitali, L; Gallerani, E; Boninsegni, P; Mediati, RD; De Gaudio, AR
Clinical Drug Investigation, 29(): 25-30.

Archives of Orthopaedic and Trauma Surgery
The effects of pre-emptive analgesia with bupivacaine on acute post-laminectomy pain
Mordeniz, C; Torun, F; Soran, AF; Beyazoglu, O; Karabag, H; Cakir, A; Yucetas, SC
Archives of Orthopaedic and Trauma Surgery, 130(2): 205-208.
10.1007/s00402-009-0961-2
CrossRef
Journal of Bone and Joint Surgery-American Volume
Acute pain following musculoskeletal injuries and orthopaedic surgery - Mechanisms and management
Ekman, EF; Koman, LA
Journal of Bone and Joint Surgery-American Volume, 86A(6): 1316-1327.

British Journal of Oral & Maxillofacial Surgery
A double-blind randomised controlled clinical trial of the effect of preoperative ibuprofen, diclofenac, paracetamol with codeine and placebo tablets for relief of postoperative pain after removal of impacted third molars
Joshi, A; Parara, E; Macfarlane, TV
British Journal of Oral & Maxillofacial Surgery, 42(4): 299-306.
10.1016/j.bioms.2004.02.004
CrossRef
Expert Opinion on Pharmacotherapy
Pharmacological interventions and concepts of fast-track perioperative medical care for enhanced recovery programs
Kranke, P; Redel, A; Schuster, F; Muellenbach, R; Eberhart, L
Expert Opinion on Pharmacotherapy, 9(9): 1541-1564.
10.1517/14656560802098402
CrossRef
Anesthesia and Analgesia
Local Administration of Morphine for Analgesia After Autogenous Anterior or Posterior Iliac Crest Bone Graft Harvest for Spinal Fusion: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
Wai, EK; Sathiaseelan, S; O'Neil, J; Simchison, BL
Anesthesia and Analgesia, 110(3): 928-933.
10.1213/ANE.0b013e3181cb3f32
CrossRef
Anesthesia and Analgesia
Preoperative interscalene block for elective shoulder surgery: Loss of benefit over early postoperative block after patient discharge to home
Wurm, WH; Concepcion, M; Sternlicht, A; Carabuena, JM; Robelen, G; Goudas, LC; Strassels, SA; Carr, DB
Anesthesia and Analgesia, 97(6): 1620-1626.
10.1213/01.ANE.0000090320.46129.BE
CrossRef
Veterinary Anaesthesia and Analgesia
Systemic lidocaine infusion as an analgesic for intraocular surgery in dogs: a pilot study
Smith, LJ; Bentley, E; Shih, A; Miller, PE
Veterinary Anaesthesia and Analgesia, 31(1): 53-63.

Anesthesia and Analgesia
Preoperative sciatic nerve block decreases mechanical allodynia more in young rats: Is preemptive analgesia developmentally modulated?
Ririe, DG; Barclay, D; Prout, H; Tong, CY; Tobin, JR; Eisenach, JC
Anesthesia and Analgesia, 99(1): 140-145.
10.1213/01.ANE.0000114181.69204.72
CrossRef
Neuroscience Research
Preemptive analgesia by zaltoprofen that inhibits bradykinin action and cyclooxygenase in a post-operative pain model
Muratani, T; Doi, Y; Nishimura, W; Nishizawa, M; Minami, T; Ito, S
Neuroscience Research, 51(4): 427-433.
10.1016/j.neures.2004.12.010
CrossRef
World Journal of Surgery
Groin hernia repair: Anesthesia
Kehlet, H; Aasvang, E
World Journal of Surgery, 29(8): 1058-1061.
10.1007/s00268-005-7969-8
CrossRef
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics
The effects on postoperative oral surgery pain by varying NSAID administration times: Comparison on effect of preemptive analgesia
Jung, YS; Kim, MK; Um, YJ; Park, HS; Lee, EW; Kang, JW
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, 100(5): 559-563.
10.1016/j.tripleo.2005.02.065
CrossRef
Veterinary Research Communications
Multimodal and balanced analgesia
Corletto, F
Veterinary Research Communications, 31(): 59-63.
10.1007/s11259-007-0085-5
CrossRef
Ophthalmic Surgery Lasers & Imaging
Preemptive sub-Tenon's anesthesia for Pars Plana Vitrectomy under general anesthesia: Is it effective?
Smiddy, WE; Gayer, S
Ophthalmic Surgery Lasers & Imaging, 39(5): 438.

Annales Francaises D Anesthesie Et De Reanimation
Ropivacaine infiltration during breast cancer surgery: Postoperative acute and chronic pain effect
Baudry, G; Steghens, A; Laplaza, D; Koeberle, P; Bachour, K; Bettinger, G; Combier, F; Samain, E
Annales Francaises D Anesthesie Et De Reanimation, 27(): 979-986.
10.1016/j.annfar.2008.10.006
CrossRef
Pain Medicine
The Effect of Preemptive Analgesia in Postoperative Pain Relief-A Prospective Double-Blind Randomized Study
Hariharan, S; Moseley, H; Kumar, A; Raju, S
Pain Medicine, 10(1): 49-53.
10.1111/j.1526-4637.2008.00547.x
CrossRef
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery
Burmeister, MA; Gottschalk, A; Frcitag, M; Horn, EP; Bohme, C; Becker, C; Standl, TG
Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie, 50(6): 568-573.

European Journal of Cardio-Thoracic Surgery
Early postoperative pain management after thoracic surgery; pre- and postoperative versus postoperative epidural analgesia: a randomised study
Yegin, A; Erdogen, A; Kayacan, N; Karsli, B
European Journal of Cardio-Thoracic Surgery, 24(3): 420-424.
10.1016/S1010-7940(03)000345-2
CrossRef
Anaesthesia
A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty
Fischer, HBJ; Simanski, CJP; Sharp, C; Bonnet, F; Camu, F; Neugebauer, EAM; Rawal, N; Joshi, GP; Schug, SA; Kehlet, H
Anaesthesia, 63(): 1105-1123.
10.1111/j.1365-2044.2008.05565.x
CrossRef
Australian Dental Journal
Pre-emptive ibuprofen arginate in third molar surgery: a double-blind randomized controlled crossover clinical trial
Lau, SL; Chow, RLK; Yeung, RWK; Samman, N
Australian Dental Journal, 54(4): 355-360.
10.1111/j.1834-7819.2009.01162.x
CrossRef
Pain
Perisurgical amitriptyline produces a preventive effect on afferent hypersensitivity following spared nerve injury
Arsenault, A; Sawynok, J
Pain, 146(3): 308-314.
10.1016/j.pain.2009.08.003
CrossRef
Acta Anaesthesiologica Scandinavica
Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: A systematic review of randomized studies
Straube, S; Derry, S; McQuay, HJ; Moore, RA
Acta Anaesthesiologica Scandinavica, 49(5): 601-613.
10.1111/j.1399-6576.2005.00666.x
CrossRef
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery
Intermittent injection of bupivacaine into the margin or the cavity after reduction mammaplasty
Holmgren, RT; Tarpila, E
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 39(4): 218-221.
10.1080/0284431051003139
CrossRef
British Journal of Anaesthesia
Pre-emptive analgesia with thoracic paravertebral blockade?
Lonnqvist, PA
British Journal of Anaesthesia, 95(6): 727-728.
10.1093/bja/aei268
CrossRef
Anesthesia and Analgesia
Preincisional treatment to prevent pain after ambulatory hernia surgery
Pavlin, DJ; Horvath, KD; Pavlin, EG; Sima, K
Anesthesia and Analgesia, 97(6): 1627-1632.
10.1213/01.ANE.0000090150.65393.E9
CrossRef
Anesthesia and Analgesia
Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery?
Suresh, S; Barcelona, SL; Young, NM; Heffner, CL; Cote, CJ
Anesthesia and Analgesia, 98(2): 330-333.
10.1213/01.ANE.0000097171.73374.AD
CrossRef
Anesthesia and Analgesia
Characterization of a new animal model for evaluation of persistent postthoracotomy pain
Buvanendran, A; Kroin, JS; Kerns, JM; Nagalla, SNK; Tuman, KJ
Anesthesia and Analgesia, 99(5): 1453-1460.
10.1213/01.ANE.0000134806.61887.0D
CrossRef
Brain Research Reviews
The importance of 'awareness' for understanding fetal pain
Mellor, DJ; Diesch, TJ; Gunn, AJ; Bennet, L
Brain Research Reviews, 49(3): 455-471.
10.1016/j.brainresrev.2005.01.006
CrossRef
Brain Research
Enhancement of morphine antinociception with the peptide N-methyl-D-aspartate receptor antagonist [Ser(1)]-histogranin in the rat formalin test
Hama, A; Basler, A; Sagen, J
Brain Research, 1095(): 59-64.
10.1016/j.brainres.2006.04.012
CrossRef
Bmc Musculoskeletal Disorders
Perioperative celecoxib administration for pain management after total knee arthroplasty - A randomized, controlled study
Huang, YM; Wang, CM; Wang, CT; Lin, WP; Horng, LC; Jiang, CC
Bmc Musculoskeletal Disorders, 9(): -.
ARTN 77
CrossRef
European Journal of Cardio-Thoracic Surgery
Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomized controlled trial
Sihoe, ADL; Manlulu, AV; Lee, TW; Thung, KH; Yim, APC
European Journal of Cardio-Thoracic Surgery, 31(1): 103-108.
10.1016/j.ejcts.2006.09.035
CrossRef
Cns Drugs
Perioperative pain management
Pyati, S; Gan, TJ
Cns Drugs, 21(3): 185-211.

Anesthesia and Analgesia
Perioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures
Sun, T; Sacan, O; White, PF; Coleman, J; Rohrich, RJ; Kenkel, JM
Anesthesia and Analgesia, 106(3): 950-958.
10.1213/ane.0b013e3181618831
CrossRef
Anesthesia and Analgesia
Perioperative Analgesia: What Do We Still Know?
White, PF; Kehlet, H; Liu, S
Anesthesia and Analgesia, 108(5): 1364-1367.
10.1213/ane.0b013e3181a16835
CrossRef
Burns
The management of pain in the burns unit
Richardson, P; Mustard, L
Burns, 35(7): 921-936.
10.1016/j.burns.2009.03.003
CrossRef
Regional Anesthesia and Pain Medicine
Evaluation of the Addition of Bupivacaine to Intrathecal Morphine and Fentanyl for Postoperative Pain Management in Laparascopic Liver Resection
Nguyen, M; Vandenbroucke, F; Roy, JD; Beaulieu, D; Seal, RF; Lapointe, R; Dagenais, M; Roy, A; Massicotte, L
Regional Anesthesia and Pain Medicine, 35(3): 261-266.
10.1097/AAP.0b013e3181de12e4
CrossRef
Wiener Klinische Wochenschrift
Preoperative oral administration of fast-release morphine sulfate reduces postoperative piritramide consumption
Reiter, A; Zulus, E; Hartmann, T; Hoerauf, K
Wiener Klinische Wochenschrift, 115(): 417-420.

Anesthesia and Analgesia
Preoperative rofecoxib oral suspension as an analgesic adjunct after lower abdominal surgery: The effects on effort-dependent pain and pulmonary function
Sinatra, RS; Shen, QHJ; Halaszynski, T; Luther, MA; Shaheen, Y
Anesthesia and Analgesia, 98(1): 135-140.
10.1213/01.ANE.0000085637.00864.D7
CrossRef
Annales Francaises D Anesthesie Et De Reanimation
Increase in bispectral index induced by antihyperalgesic dose of ketamine
Chaaben, K; Marret, E; Lamonerie, L; Lembert, N; Bonnet, F
Annales Francaises D Anesthesie Et De Reanimation, 23(5): 513-516.
10.1016/j.annfar.2004.02.048
CrossRef
International Journal of Oral and Maxillofacial Surgery
Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain
Ong, KS; Seymour, RA; Chen, FG; Ho, VCL
International Journal of Oral and Maxillofacial Surgery, 33(8): 771-776.
10.1016/j.ijom.2004.01.020
CrossRef
Anaesthesia
Impact on postoperative pain of long-lasting pre-emptive epidural analgesia before total hip replacement: a prospective, randomised, double-blind study
Klasen, J; Haas, M; Graf, S; Harbach, H; Quinzio, L; Jurgensen, I; Hempelmann, G
Anaesthesia, 60(2): 118-123.

Current Drug Targets
Analgesia in PACU: Nonsteroidal anti-inflammatory drugs
Della Rocca, G; Chiarandini, P; Pietropaoli, P
Current Drug Targets, 6(7): 781-787.

Anesthesia and Analgesia
Preemptive analgesia at the crossroad
Kissin, I
Anesthesia and Analgesia, 100(3): 754-756.
10.1213/01.ANE.0000144429.39988.9B
CrossRef
Anesthesia and Analgesia
The efficacy of preemptive analgesia for acute postoperative pain management: A meta-analysis
Ong, CKS; Lirk, P; Seymour, RA; Jenkins, BJ
Anesthesia and Analgesia, 100(3): 757-773.
10.1213/01.ANE.0000144428.98767.0E
CrossRef
Journal of Neuroscience
Inhibition by spinal mu- and delta-opioid agonists of afferent-evoked substance P release
Kondo, I; Marvizon, JCG; Song, BB; Salgado, F; Codeluppi, S; Hua, XY; Yaksh, TL
Journal of Neuroscience, 25(): 3651-3660.
10.1523/JNEUROSCI.0252-05.2005
CrossRef
Regional Anesthesia and Pain Medicine
Long-Lasting Analgesic Effects of Intraoperative Thoracic Epidural With Bupivacaine for Liver Resection
Mondor, ME; Massicotte, L; Beaulieu, D; Roy, JD; Lapointe, R; Dagenais, M; Roy, A
Regional Anesthesia and Pain Medicine, 35(1): 51-56.
10.1097/AAP.0b013e3181c6f8f2
CrossRef
European Journal of Cardio-Thoracic Surgery
Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy
Fiorelli, A; Vicidomini, G; Laperuta, P; Busiello, L; Perrone, A; Napolitano, F; Messina, G; Santini, M
European Journal of Cardio-Thoracic Surgery, 37(3): 588-593.
10.1016/j.ejcts.2009.07.040
CrossRef
Annales Francaises D Anesthesie Et De Reanimation
Efficiency of bupivacaine wound subfasciale infiltration in reduction of postoperative pain after inguinal hernia surgery
Mounir, K; Bensghir, M; Elmoqaddem, A; Massou, S; Belyamani, L; Atmani, M; Azendour, H; Kamili, ND
Annales Francaises D Anesthesie Et De Reanimation, 29(4): 274-278.
10.1016/j.annfar.2009.12.020
CrossRef
European Journal of Pharmacology
Prolonged analgesic effect of amitriptyline base on thermal hyperalgesia in an animal model of neuropathic pain
Huang, KL; Shieh, JP; Chu, CC; Cheng, KI; Wang, JJ; Lin, MT; Yeh, MY
European Journal of Pharmacology, 702(): 20-24.
10.1016/j.ejphar.2012.12.032
CrossRef
Pain Physician
Pre-Emptive and Multi-Modal Perioperative Pain Management May Improve Quality of Life in Patients Undergoing Spinal Surgery
Lee, BH; Park, JO; Suk, KS; Kim, TH; Lee, HM; Park, MS; Lee, SH; Park, S; Lee, JY; Ko, SK; Moon, SH
Pain Physician, 16(3): E217-E226.

Cns Neuroscience & Therapeutics
Ketamine in Pain Management
Persson, J
Cns Neuroscience & Therapeutics, 19(6): 396-402.
10.1111/cns.12111
CrossRef
World Journal of Surgery
Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS((R))) Society Recommendations
Lassen, K; Coolsen, MME; Slim, K; Carli, F; de Aguilar-Nascimento, JE; Schafer, M; Parks, RW; Fearon, KCH; Lobo, DN; Demartines, N; Braga, M; Ljungqvist, O; Dejong, CHC
World Journal of Surgery, 37(2): 240-258.
10.1007/s00268-012-1771-1
CrossRef
Journal of Cranio-Maxillofacial Surgery
Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery
Santos, JASD; da Silva, LCF; Santos, TD; Menezes, LR; Oliveira, ACD; Brandao, JRMCB
Journal of Cranio-Maxillofacial Surgery, 40(8): 694-700.
10.1016/j.jcms.2012.01.001
CrossRef
Clinical Nutrition
Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS (R)) Society recommendations
Lassen, K; Coolsen, MME; Slim, K; Carli, F; de Aguilar-Nascimento, JE; Schafer, M; Parks, RW; Fearon, KCH; Lobo, DN; Demartines, N; Braga, M; Ljungqvist, O; Dejong, CHC
Clinical Nutrition, 31(6): 817-830.
10.1016/j.clnu.2012.08.011
CrossRef
Journal of Obstetrics and Gynaecology
Pre-incisional, post-incisional and combined pre- and post-incisional local wound infiltrations with lidocaine in elective caesarean section delivery: A randomised clinical trial
Fouladi, RF; Navali, N; Abbassi, A
Journal of Obstetrics and Gynaecology, 33(1): 54-59.
10.3109/01443615.2012.719945
CrossRef
Minerva Anestesiologica
Preoperative medication with oral morphine sulphate and postoperative pain
Borracci, T; Cappellini, I; Campiglia, L; Picciafuochi, F; Berti, J; Consales, G; De Gaudio, AR
Minerva Anestesiologica, 79(5): 525-533.

Pain Physician
Multivariate Prognostic Modeling of Persistent Pain Following Lumbar Discectomy
Hegarty, D; Shorten, G
Pain Physician, 15(5): 421-434.

Anesthesiology
Preemptive Analgesia: What Do We Do Now?
Gottschalk, A; Ochroch, E
Anesthesiology, 98(1): 280-281.

Anesthesiology
Effects of Halothane and Isoflurane on Hyperexcitability of Spinal Dorsal Horn Neurons after Incision in the Rat
Kawamata, M; Narimatsu, E; Kozuka, Y; Takahashi, T; Sugino, S; Niiya, T; Namiki, A
Anesthesiology, 102(1): 165-174.

PDF (1083)
Anesthesiology
Improving Postoperative Pain Management: What Are the Unresolved Issues?
White, PF; Kehlet, H
Anesthesiology, 112(1): 220-225.
10.1097/ALN.0b013e3181c6316e
PDF (588) | CrossRef
Anesthesiology
No Preemptive Analgesia: Is That So Bad?
Hogan, QH
Anesthesiology, 96(3): 526-527.

Anesthesiology
Preventing and Treating Pain after Thoracic Surgery
Gottschalk, A; Cohen, SP; Yang, S; Ochroch, EA
Anesthesiology, 104(3): 594-600.

PDF (925)
Anesthesiology
Analgesic Treatment after Laparoscopic Cholecystectomy: A Critical Assessment of the Evidence
Bisgaard, T
Anesthesiology, 104(4): 835-846.

PDF (371)
Anesthesiology
Postoperative Morphine Use and Hyperalgesia Are Reduced by Preoperative but Not Intraoperative Epidural Analgesia: Implications for Preemptive Analgesia and the Prevention of Central Sensitization
Katz, J; Cohen, L; Schmid, R; Chan, VW; Wowk, A
Anesthesiology, 98(6): 1449-1460.

PDF (497)
Anesthesiology
Effects of Postoperative, Nonsteroidal, Antiinflammatory Drugs on Bleeding Risk after Tonsillectomy Meta-analysis of Randomized, Controlled Trials
Warltier, DC; Marret, E; Flahault, A; Samama, C; Bonnet, F
Anesthesiology, 98(6): 1497-1502.

PDF (244)
Anesthesiology
Reduction of Postincisional Allodynia by Subcutaneous Bupivacaine: Findings with a New Model in the Hairy Skin of the Rat
Duarte, AM; Pospisilova, E; Reilly, E; Mujenda, F; Hamaya, Y; Strichartz, GR
Anesthesiology, 103(1): 113-125.

PDF (1617)
Anesthesiology
The Pharmacologic Treatment of Muscle Pain
Cohen, SP; Mullings, R; Abdi, S
Anesthesiology, 101(2): 495-526.

PDF (916)
Anesthesiology
Frontiers in Translational Research: The Etiology of Incisional and Postoperative Pain
Brennan, TJ
Anesthesiology, 97(3): 535-537.

Anesthesiology
A Randomized Study of the Effects of Single-dose Gabapentin versus Placebo on Postoperative Pain and Morphine Consumption after Mastectomy
Dirks, J; Fredensborg, BB; Christensen, D; Fomsgaard, JS; Flyger, H; Dahl, JB
Anesthesiology, 97(3): 560-564.

PDF (105)
Anesthesiology
Preventive Analgesia to Reduce Wound Hyperalgesia and Persistent Postsurgical Pain: Not an Easy Path
Brennan, TJ; Kehlet, H
Anesthesiology, 103(4): 681-683.

PDF (229)
Anesthesiology
Intraoperative Epidural Analgesia Combined with Ketamine Provides Effective Preventive Analgesia in Patients Undergoing Major Digestive Surgery
Lavand’homme, P; De Kock, M; Waterloos, H
Anesthesiology, 103(4): 813-820.

PDF (826)
Anesthesiology
Long-term Pain and Activity during Recovery from Major Thoracotomy Using Thoracic Epidural Analgesia
Ochroch, EA; Gottschalk, A; Augostides, J; Carson, KA; Kent, L; Malayaman, N; Kaiser, LR; Aukburg, SJ
Anesthesiology, 97(5): 1234-1244.

PDF (886)
Anesthesiology
Arthroscopic Knee Surgery Does Not Modify Hyperalgesic Responses to Heat Injury
Werner, MU; Duun, P; Kraemer, O; Lassen, B; Kehlet, H
Anesthesiology, 99(5): 1152-1157.

PDF (282)
Anesthesiology
Severing the Link between Acute and Chronic Pain: The Anesthesiologist's Role in Preventive Medicine
Gottschalk, A; Raja, SN
Anesthesiology, 101(5): 1063-1065.

PDF (234)
Anesthesiology
Intrathecal Injection of the ς1 Receptor Antagonist BD1047 Blocks Both Mechanical Allodynia and Increases in Spinal NR1 Expression during the Induction Phase of Rodent Neuropathic Pain
Roh, D; Kim, H; Yoon, S; Seo, H; Kwon, Y; Kim, K; Han, H; Beitz, AJ; Na, H; Lee, J
Anesthesiology, 109(5): 879-889.
10.1097/ALN.0b013e3181895a83
PDF (1191) | CrossRef
Anesthesiology
Mechanisms of Postoperative Pain: Clinical Indications for a Contribution of Central Neuronal Sensitization
Dirks, J; Møiniche, S; Hilsted, K; Dahl, JB
Anesthesiology, 97(6): 1591-1596.

PDF (247)
Critical Care Medicine
The evolution of pain management in the critically ill trauma patient: Emerging concepts from the global war on terrorism
Malchow, RJ; Black, IH
Critical Care Medicine, 36(7): S346-S357.
10.1097/CCM.0b013e31817e2fc9
PDF (423) | CrossRef
The Clinical Journal of Pain
High and Low Frequency TENS Reduce Postoperative Pain Intensity After Laparoscopic Tubal Ligation: A Randomized Controlled Trial
DeSantana, JM; Sluka, KA; Lauretti, GR
The Clinical Journal of Pain, 25(1): 12-19.
10.1097/AJP.0b013e31817d1070
PDF (255) | CrossRef
The Clinical Journal of Pain
Preoperative Cotreatment With Dextromethorphan and Ketorolac Provides an Enhancement of Pain Relief After Laparoscopic-assisted Vaginal Hysterectomy
Lu, C; Liu, J; Lee, M; Borel, CO; Yeh, C; Wong, C; Wu, C
The Clinical Journal of Pain, 22(9): 799-804.
10.1097/01.ajp.0000210931.20322.da
PDF (158) | CrossRef
Current Opinion in Anesthesiology
Can we predict persistent postoperative pain by testing preoperative experimental pain?
Granot, M
Current Opinion in Anesthesiology, 22(3): 425-430.
10.1097/ACO.0b013e32832a40e1
PDF (133) | CrossRef
Diseases of the Colon & Rectum
Pudendal Block with Bupivacaine for Postoperative Pain Relief
Imbelloni, LE; Vieira, EM; Gouveia, MA; Netinho, JG; Spirandelli, LD; Cordeiro, JA
Diseases of the Colon & Rectum, 50(10): 1656-1661.
10.1007/s10350-007-0216-7
PDF (212) | CrossRef
European Journal of Anaesthesiology (EJA)
Flagging the pain: preventing the burden of chronic pain by identifying and treating risk factors in acute pain
Shipton, EA; Tait, B
European Journal of Anaesthesiology (EJA), 22(6): 405-412.
10.1017/S0265021505000694
PDF (97) | CrossRef
European Journal of Anaesthesiology (EJA)
Intraoperative epidural analgesia does not reduce time of postoperative analgesic treatment compared to intravenous analgesia
Schulte, E; Hoffmann, B; Höhne, C; Hofmann, M; Olenberger, W; Fritz, GA
European Journal of Anaesthesiology (EJA), 25(9): 763-765.
10.1017/S0265021508004031
PDF (68) | CrossRef
European Journal of Anaesthesiology (EJA)
Intravenous morphine and droperidol after caesarean delivery under subarachnoid anaesthesia has no effect on postoperative pain or analgesic requirements
Paraskeva, A; Staikou, C; Melemeni, A; Fassoulaki, A
European Journal of Anaesthesiology (EJA), 26(10): 847-850.
10.1097/EJA.0b013e32832a985c
PDF (325) | CrossRef
Obstetrics & Gynecology
The Effect of Preemptive Pudendal Nerve Blockade on Pain After Transvaginal Pelvic Reconstructive Surgery
Abramov, Y; Sand, PK; Gandhi, S; Botros, SM; Miller, JR; Koh, E; Goldberg, RP
Obstetrics & Gynecology, 106(4): 782-788.
10.1097/01.AOG.0000165275.39905.0d
PDF (218) | CrossRef
Ophthalmic Plastic & Reconstructive Surgery
Effect of Preemptive Retrobulbar Analgesia on Perioperative Hemodynamics and Postoperative Pain After Enucleation
Yeatts, RP; Doneyhue, W; Scuderi, PE; Brasington, CR; James, R
Ophthalmic Plastic & Reconstructive Surgery, 20(3): 226-231.

PDF (137)
Plastic and Reconstructive Surgery
Cosmetic Surgery: Postoperative Pain and Postoperative Nausea and Vomiting––Dissociative Anesthesia Reconsidered
Friedberg, BL
Plastic and Reconstructive Surgery, 125(4): 184e-185e.
10.1097/PRS.0b013e3181d45e40
PDF (8979) | CrossRef
Plastic and Reconstructive Surgery
Discussion
Pacik, PT
Plastic and Reconstructive Surgery, 115(7): 1935-1936.
10.1097/01.PRS.0000163320.57517.12
PDF (48) | CrossRef
Plastic and Reconstructive Surgery
Outpatient Abdominoplasty Facilitated by Rib Blocks
Michaels, BM; Eko, FN
Plastic and Reconstructive Surgery, 124(2): 635-642.
10.1097/PRS.0b013e3181addbd7
PDF (608) | CrossRef
Plastic and Reconstructive Surgery
Efficacy of the Pain Pump Catheter in Immediate Autologous Breast Reconstruction
Baroody, M; Tameo, MN; Dabb, RW
Plastic and Reconstructive Surgery, 114(4): 895-898.
10.1097/01.PRS.0000133173.71201.3C
PDF (280) | CrossRef
Plastic and Reconstructive Surgery
Practice Advisory on Pain Management and Prevention of Postoperative Nausea and Vomiting
Iverson, RE; Lynch, DJ; ASPS Committee on Patient Safety,
Plastic and Reconstructive Surgery, 118(4): 1060-1069.
10.1097/01.prs.0000232390.14109.f5
PDF (354) | CrossRef
Back to Top | Article Outline

© 2002 American Society of Anesthesiologists, Inc.

Publication of an advertisement in Anesthesiology Online does not constitute endorsement by the American Society of Anesthesiologists, Inc. or Lippincott Williams & Wilkins, Inc. of the product or service being advertised.
Login

Article Tools

Images

Share